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
11-5-2023 12:45 PM
End Date
11-5-2023 1:00 PM
Presentation Type
Oral Presentation
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: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.
Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. Operative times as well as different parameters for blood loss were compared between first cases and second cases, termed the “first/second” group. This same data was also compared chronologically between the first 50% and last 50% of cases, regardless of which case was performed first or second on the day of surgery, termed the “chronologic” group. Lastly, subgroup analysis was carried out for first cases and second cases, where each group was broken down chronologically (eg. first 50% of first cases, last 50% of first cases) and compared, termed the “50/50” group.
Results: 56 patients (73% female, aged 15.2 ± 1.8 years) were included in this analysis. In the “first/second” group, the first case of the day on average had significantly slower ‘in room to incision times’ compared to the second case of the day (68.4 ± 10.5 vs. 60.8 ± 7.5 min, p=0.003). No other surgery times or blood loss were significantly different. This data can be found in Table 1. In the “chronologic” group, the first half of patients who underwent surgery on “Two Spine Tuesday” had significantly longer ‘last implant to last rod’ times (50.5 ± 12.3 vs. 40.6 ± 12.1 min, p=0.004), ‘last rod to bone graft insertion’ times (18.2 ± 6.2 vs. 12.9 ± 8.4 min, p=0.01), and overall surgery times (219.4 ± 44.5 vs. 197.1 ± 35.0 min, p=0.04). There was no difference in other times or blood loss. This data can be found in Table 2. One patient had revision surgery for pseudarthrosis 2 years postoperatively. There were no other major complications.
Conclusions: Performing two AIS cases in one OR by two surgeons during the same day resulted in a steady and significant decrease in surgery times over the course of this study, with very few complications. As surgical staff become more used to this structure, efficiency increases and operative times improve, 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 AIS Cases, Two Surgeons, One Operating Room, One Day. The Results of a Quality Improvement Initiative
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: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.
Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. Operative times as well as different parameters for blood loss were compared between first cases and second cases, termed the “first/second” group. This same data was also compared chronologically between the first 50% and last 50% of cases, regardless of which case was performed first or second on the day of surgery, termed the “chronologic” group. Lastly, subgroup analysis was carried out for first cases and second cases, where each group was broken down chronologically (eg. first 50% of first cases, last 50% of first cases) and compared, termed the “50/50” group.
Results: 56 patients (73% female, aged 15.2 ± 1.8 years) were included in this analysis. In the “first/second” group, the first case of the day on average had significantly slower ‘in room to incision times’ compared to the second case of the day (68.4 ± 10.5 vs. 60.8 ± 7.5 min, p=0.003). No other surgery times or blood loss were significantly different. This data can be found in Table 1. In the “chronologic” group, the first half of patients who underwent surgery on “Two Spine Tuesday” had significantly longer ‘last implant to last rod’ times (50.5 ± 12.3 vs. 40.6 ± 12.1 min, p=0.004), ‘last rod to bone graft insertion’ times (18.2 ± 6.2 vs. 12.9 ± 8.4 min, p=0.01), and overall surgery times (219.4 ± 44.5 vs. 197.1 ± 35.0 min, p=0.04). There was no difference in other times or blood loss. This data can be found in Table 2. One patient had revision surgery for pseudarthrosis 2 years postoperatively. There were no other major complications.
Conclusions: Performing two AIS cases in one OR by two surgeons during the same day resulted in a steady and significant decrease in surgery times over the course of this study, with very few complications. As surgical staff become more used to this structure, efficiency increases and operative times improve, which may reduce overall complications and has potential for meaningful cost savings.
