Title

A Dedicated Pediatric Spine Deformity Team Significantly Reduces Surgical Time and Cost.

Year of Publication

2018

Number of Pages

1574-1580

Date Published

2018 Sep 19

ISSN Number

1535-1386

Abstract

<p><strong>BACKGROUND: </strong>As high-quality health care becomes increasingly expensive, improvement projects are focused on reducing cost and increasing value. To increase value by reducing operating room (OR) utilization, we studied the effect of a dedicated team approach for posterior spinal fusion (PSF) for scoliosis.</p>

<p><strong>METHODS: </strong>With institutional support, an interdisciplinary, dedicated team was assembled. Members developed standardized protocols for anesthetic management and patient transport, positioning, preparation, draping, imaging, and wake-up. These protocols were initially implemented with a small interdisciplinary team, including 1 surgeon (Phase 1), and then were expanded to include a second surgeon and additional anesthesiology staff (Phase 2). We compared procedures performed with a dedicated team (the Dedicated Team cases) and procedures performed without a such a team (the Casual Team cases). Because of the heterogeneous nature of PSF for scoliosis, we developed a case categorization system: Category 1 was relatively homogeneous and indicated patients with fusion of ≤12 levels, no osteotomies, and a body mass index (BMI) of &lt;25 kg/m, and Category 2 was more heterogeneous and indicated patients with fusion of &gt;12 levels and/or ≥1 osteotomy and/or a BMI of ≥25 kg/m.</p>

<p><strong>RESULTS: </strong>In total, 89 Casual Team and 78 Dedicated Team cases were evaluated: 71 were in Category 1 and 96 were in Category 2. Dedicated Team cases used significantly less OR time for both Categories 1 and 2 (p &lt; 0.001). In Category-1 cases, the average reduction was 111.4 minutes (29.7%); in Category-2 cases, it was 76.9 minutes (18.5%). The effect of the Dedicated Team was scalable: the reduction in OR time was significant in both Phase 1 and Phase 2 (p &lt; 0.001). The Dedicated Team cases had no complications. Cost reduction averaged approximately $8,900 for Category-1 and $6,000 for Category-2 cases.</p>

<p><strong>CONCLUSIONS: </strong>By creating a dedicated team and standardizing several aspects of PSFs for scoliosis, we achieved a large reduction in OR time. This increase in team efficiency was significant, consistent, and scalable. As a result, we can routinely complete 2 Category-1 PSFs in the same OR with the same team without exceeding standard block time.</p>

DOI

10.2106/JBJS.17.01584

Alternate Title

J Bone Joint Surg Am

PMID

30234621

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