Interdisciplinary Optimization Clinic Decreases Infection in Neuromuscular/Syndromic Scoliosis Patients

Abstract

Spinal surgery in pediatric neuromuscular and syndromic (NMS) patients is associated with numerous perioperative adverse events, unplanned reoperations, and suboptimal outcomes. This quality initiative (QI) focused on the development of a patient-centered interdisciplinary medical optimization clinic and implementation of a standardized care pathway for NMS spinal fusion patients.In 2017, an interdisciplinary committee was formed with the purpose of creating a patient-centered medical optimization clinic (NSP) for surgical patients with neuromuscular and syndromic scoliosis. The aims of the initiative were to 1) measure compliance to the implemented NSP clinical pathway, 2) create a mobile App to coordinate care 3)to reduce infections (SSI) in NMS spinal fusion patients to a target goal of zero.Over two years, 160 NMS patients underwent spinal fusion. Twenty-nine (18%) of those were medically optimized in the NSP clinic. The average age was 12.8 years, preop cobb angle was 85.4 degrees, the preoperative kyphosis was 76.1 degrees, and the average preoperative BMI was 17.4. The average preoperative SSI RSS was calculated to be 19.69%. None of the 29 NSP patients developed an SSI, whereas 6.9% of the remaining 131 NMS scoliosis fusion patients that were not evaluated in the NSP clinic developed an SSI. (p = 0.015)In summary, the NSP clinic cohort had a 20% predicted risk of developing a HAI SSI, and the actual rate was 0%. In contrast, 6.9% of the NMS scoliosis fusion patients that were not evaluated in the NSP clinic developed an SSI. As a result of this QI study, ALL NMS spinal fusion patients at our institution are medically optimized through the NSP clinic.