P61. A significant number of elective spine surgery plans are altered by a weekly indications conference with high surgeon compliance

Abstract

BACKGROUND CONTEXT Rates and costs of elective spine surgery have skyrocketed in recent years, yet many patients continue to experience poor outcomes. Furthermore, no standardized appropriateness criteria exist for spinal procedures. Identifying methods for pairing the proper patient with the optimal intervention is of the utmost importance. Prior studies have evaluated the utility of multidisciplinary of spine conferences for patient management, but none have evaluated the impact of a multidisciplinary surgical indications conference (MSIC) on surgical planning and decision making. PURPOSE To characterize the impact a weekly MSIC has on surgical planning and the compliance rates of surgeons with a MSIC's decisions. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE There were 100 consecutive patients presented at a weekly MSIC. OUTCOME MEASURES Rates of surgical planning alterations. Compliance rates with the MSIC's decisions 30-day postoperative complication and readmission rates for patients undergoing surgery after review at a MSIC. METHODS We reviewed consecutive cases at our institution's weekly MSIC from September-December 2019 where three neurosurgical and three orthopedic spine surgeons discuss each upcoming surgery. Every elective surgery at the institution was presented and each surgeon voiced their opinion before a group consensus decision was made on how to proceed. Patient demographics, comorbidities, surgeon specific information, the proposed surgery, invasiveness rating, group consensus for each surgery, surgeon compliance with the group consensus, and 30-day complication and readmission data were collected. Descriptive statistics were performed for the group's decision to accept or alter a proposed surgery. A binomial test was utilized to determine if the proportion of altered surgical plans significantly differed from zero. Univariate analysis was performed using chi-squared tests and Fisher's exact test for categorical variables and t-tests and Wilcoxon rank-sum test for continuous variables to compare differences between surgical cases approved without changes and those that the group altered. RESULTS We reviewed 100 consecutive patients scheduled for elective spine surgery at our indications conference during the study period. The group determined that surgical plans should be altered in 19 cases (19%), with three of these cases being postponed or cancelled, which was statistically significant utilizing a binomial test (p CONCLUSIONS MSICs can lead to surgical planning alterations in a significant number of cases. This may result in better selection of surgical candidates and procedures for particular patients, leading to better outcomes and providing greater value to patients. Surgeon compliance with the MSIC's decisions was high, suggesting surgeons are willing to adhere to a MSIC's advice. Although long-term patient outcomes remain to be evaluated, this care model will likely play an integral role in optimizing the care spine surgeons provide patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.