Presenter Status
Resident/Ph.D/Post graduate (> 1 month of dedicated research time)
Abstract Type
Research
Primary Mentor
Richard M. Schwend, M.D.
Start Date
10-5-2023 11:30 AM
End Date
10-5-2023 1:30 PM
Presentation Type
Abstract
Description
Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).
Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.
Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group 1), with data prospectively collected. During the same time, patients scheduled to undergo PSIF on other days were matched for sex and age (Group 2). Outcomes included time from entrance to the OR to first incision, total surgery time, total time from surgery stop to exiting the OR, total time spent in the OR, estimated blood loss, amount of cell saver, amount of blood transfused, 90-day readmissions, revision surgery rate, and percentage of patients who achieved the minimal clinically important difference (MCID) for SRS-22.
Results: 56 patients (73% female, aged 15.2 ± 1.8 years) composed the two-spine group, group 1. These patients were compared to 56 sex- and age-matched controls (73% female, aged 15.1 ± 1.7 years, p=0.8), Group 2. For Group 1, average Cobb angle (60 ± 13 degrees) and average number of levels fused (10.5 ± 2.2 levels) were similar to the Group 2 (57 ± 10 degrees, p=0.17; 10.3 ± 2.8 levels, p=0.7). The time from patient entrance to the OR to first incision was significantly lower for Group 1 compared to controls (p< 0.001) as were overall surgery time (208 vs 298 min ) (p< 0.001), surgery stop to out of OR time (p=0.047), total OR time (p< 0.001), and estimated blood loss (400 vs 524 cc) (p=0.02). There were no 90-day readmissions for either group and rate of revision surgery was similar (1/56 Group 1 vs. 3/56 Group 2, p=0.16). Results are shown in Table 1. Conclusions: Performing two AIS cases in one OR by two surgeons during the same day resulted in significantly faster patient preparation times, surgery times, less total time spent in the operating room, and less blood loss compared to sex- and age-matched control patients with similar Cobb angles and number of levels fused whose surgery was done by a single surgeon. Historically, every minute in the OR costs $200. Using this system, we saved an average 100 minutes of OR time per case, equating to $200,000 saved per case and up to $400,000 saved per “Two Spine Tuesday.” Using this model, surgery time for AIS cases can be faster compared to single-surgeon cases, which may reduce overall complications and has potential for meaningful cost savings.
MeSH Keywords
Scoliosis; Spine; Instrumentation and Fusion; Quality Improvement; OR Time
Included in
Two Adolescent Idiopathic Scoliosis (AIS) Cases, Two Surgeons, One Operating Room, One Day. Faster and Safer Than One Case in a Day.
Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).
Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.
Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group 1), with data prospectively collected. During the same time, patients scheduled to undergo PSIF on other days were matched for sex and age (Group 2). Outcomes included time from entrance to the OR to first incision, total surgery time, total time from surgery stop to exiting the OR, total time spent in the OR, estimated blood loss, amount of cell saver, amount of blood transfused, 90-day readmissions, revision surgery rate, and percentage of patients who achieved the minimal clinically important difference (MCID) for SRS-22.
Results: 56 patients (73% female, aged 15.2 ± 1.8 years) composed the two-spine group, group 1. These patients were compared to 56 sex- and age-matched controls (73% female, aged 15.1 ± 1.7 years, p=0.8), Group 2. For Group 1, average Cobb angle (60 ± 13 degrees) and average number of levels fused (10.5 ± 2.2 levels) were similar to the Group 2 (57 ± 10 degrees, p=0.17; 10.3 ± 2.8 levels, p=0.7). The time from patient entrance to the OR to first incision was significantly lower for Group 1 compared to controls (p< 0.001) as were overall surgery time (208 vs 298 min ) (p< 0.001), surgery stop to out of OR time (p=0.047), total OR time (p< 0.001), and estimated blood loss (400 vs 524 cc) (p=0.02). There were no 90-day readmissions for either group and rate of revision surgery was similar (1/56 Group 1 vs. 3/56 Group 2, p=0.16). Results are shown in Table 1. Conclusions: Performing two AIS cases in one OR by two surgeons during the same day resulted in significantly faster patient preparation times, surgery times, less total time spent in the operating room, and less blood loss compared to sex- and age-matched control patients with similar Cobb angles and number of levels fused whose surgery was done by a single surgeon. Historically, every minute in the OR costs $200. Using this system, we saved an average 100 minutes of OR time per case, equating to $200,000 saved per case and up to $400,000 saved per “Two Spine Tuesday.” Using this model, surgery time for AIS cases can be faster compared to single-surgeon cases, which may reduce overall complications and has potential for meaningful cost savings.
