TY - JOUR
T1 - Does a dedicated “Scoliosis Team” and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?
AU - Sarwahi, Vishal
AU - Hasan, Sayyida
AU - Rao, Himanshu
AU - Visahan, Keshin
AU - Grunfeld, Matan
AU - Dzaugis, Peter
AU - Wendolowski, Stephen
AU - Vora, Rushabh
AU - Galina, Jesse
AU - Lo, Yungtai
AU - Moguilevitch, Marina
AU - Thornhill, Beverly
AU - Amaral, Terry
AU - DiMauro, Jon Paul
N1 - Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Scoliosis Research Society.
PY - 2023/11
Y1 - 2023/11
N2 - Purpose: The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions. Methods: A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal–Wallis, and χ 2 tests were used. Results: 500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing. Conclusion: Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.
AB - Purpose: The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions. Methods: A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal–Wallis, and χ 2 tests were used. Results: 500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing. Conclusion: Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.
KW - Adolescent idiopathic scoliosis
KW - Posterior spinal fusion
KW - Scoliosis
KW - Standardization
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U2 - 10.1007/s43390-023-00728-4
DO - 10.1007/s43390-023-00728-4
M3 - Article
C2 - 37507585
AN - SCOPUS:85174367860
SN - 2212-134X
VL - 11
SP - 1409
EP - 1418
JO - Spine deformity
JF - Spine deformity
IS - 6
ER -