Asian Spine Journal

Korean Society of Spine Surgery (대한척추외과학회)
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Impact of Multidisciplinary Spine Conferences on Surgical Planning and Perioperative Care in Elective Lumbar Spine Surgeries

  • Received : 2017.09.29
  • Accepted : 2018.01.05
  • Published : 2018.10.31
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Abstract

Study Design: Pre- and post-implementation analysis. Purpose: We examined the impact of implementing multidisciplinary spine conferences-"spine board" reviews-on the general utilization of elective lumbar spine surgeries in a tertiary medical institute. Overview of Literature: A multidisciplinary approach to spine care reportedly improves the appropriate utilization of surgical spine procedures. Methods: A multidisciplinary spine board was established to review candidates selected for elective lumbar spine surgery. The board comprised representatives from orthopedic spine surgery, neurosurgery, psychology, physical therapy, radiology, pharmacy, primary care, pain management, anesthesiology, and veteran advocacy. Two similar 6-month periods were selected to study the impact of this implementation: pre-implementing (June 1, 2015 to November 30, 2015) and post-implementation (June 1, 2016 to November 30, 2016) periods. Results: Between March 1, 2016 and December 30, 2016, the spine board discussed 11 patients. All patients underwent clinical examinations and radiological assessments findings that warranted elective lumbar surgery. The board recommended non-surgical interventions before proceeding with the planned surgeries in all cases. In the pre-implementation period, a total of 101 elective lumbar spine surgeries were performed. In the post-implementation period, a total of 51 elective lumbar spine surgeries were performed (p<0.05). The surgical plan for elective lumbar spine surgery in the post-implementation period was not directly influenced by the review of spine board because none of the cases were discussed in the conferences; however, the care occurred at a hospital where the spine board was implemented. There was no significant change in the number of cervical spine surgeries performed (66 preimplementation vs. 56 post-implementation). The average surgery duration was 52 minutes shorter in the post-implementation period compared with that in the pre-implementation period (p<0.05). Conclusions: Implementation of a multidisciplinary spine board was concurrent with an overall decrease in the utilization of lumbar spine surgeries for elective cases of low back pain in a tertiary medical center.

Keywords

Acknowledgement

Supported by : VA Maryland Health Care System

References

  1. Deyo RA. Biopsychosocial care for chronic back pain. BMJ 2015;350:h538. https://doi.org/10.1136/bmj.h538
  2. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015;350:h444. https://doi.org/10.1136/bmj.h444
  3. Deyo RA, Cherkin D, Conrad D, Volinn E. Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health 1991;12:141-56. https://doi.org/10.1146/annurev.pu.12.050191.001041
  4. Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075-94. https://doi.org/10.1007/s00586-010-1502-y
  5. Desai A, Bekelis K, Ball PA, et al. Variation in outcomes across centers after surgery for lumbar stenosis and degenerative spondylolisthesis in the spine patient outcomes research trial. Spine (Phila Pa 1976) 2013;38:678-91. https://doi.org/10.1097/BRS.0b013e318278e571
  6. Yanamadala V, Kim Y, Buchlak QD, et al. Multidisciplinary evaluation leads to the decreased utilization of lumbar spine fusion: an observational cohort pilot study. Spine (Phila Pa 1976) 2017;42:E1016-23. https://doi.org/10.1097/BRS.0000000000002065
  7. Palma L, Mariottini A, Carangelo B, Muzii VF, Zalaffi A. Favourable long-term clinical outcome after anterior cervical discectomy: a study on a series of 125 patients undergoing surgery a mean of 11 years earlier. Acta Neurochir (Wien) 2010;152:1145-52. https://doi.org/10.1007/s00701-010-0650-5
  8. Fritzell P, Knutsson B, Sanden B, Stromqvist B, Hagg O. Recurrent versus primary lumbar disc herniation surgery: patient-reported outcomes in the Swedish Spine Register Swespine. Clin Orthop Relat Res 2015;473:1978-84. https://doi.org/10.1007/s11999-014-3596-8
  9. Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Lumbar diskography and failed back syndrome in patients receiving workers' compensation. Orthopedics 2015;38:e951-8. https://doi.org/10.3928/01477447-20151020-01
  10. Cuneo JG, DeBerard MS, Wheeler AJ. Lumbar fusion in Utah workers' compensation patients: changing outcomes across a decade. Spine (Phila Pa 1976) 2017;42:692-9. https://doi.org/10.1097/BRS.0000000000001964
  11. Acute low back problems in adults: assessment and treatment: Agency for Health Care Policy and Research. Clin Pract Guidel Quick Ref Guide Clin 1994;(14):iii-iv,1-25.
  12. Monahan T, Fisher JA. Benefits of "observer effects": lessons from the field. Qual Res 2010;10:357-76. https://doi.org/10.1177/1468794110362874
  13. Fox J, Haig AJ, Todey B, Challa S. The effect of required physiatrist consultation on surgery rates for back pain. Spine (Phila Pa 1976) 2013;38:E178-84. https://doi.org/10.1097/BRS.0b013e31827bf40c
  14. Rasmussen C, Nielsen GL, Hansen VK, Jensen OK, Schioettz-Christensen B. Rates of lumbar disc surgery before and after implementation of multidisciplinary nonsurgical spine clinics. Spine (Phila Pa 1976) 2005;30:2469-73. https://doi.org/10.1097/01.brs.0000184686.70838.96
  15. Sethi RK, Pong RP, Leveque JC, Dean TC, Olivar SJ, Rupp SM. The Seattle Spine Team approach to adult deformity surgery: a systems-based approach to perioperative care and subsequent reduction in perioperative complication rates. Spine Deform 2014;2:95-103. https://doi.org/10.1016/j.jspd.2013.12.002
  16. Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis: updated Cochrane review. Spine (Phila Pa 1976) 2005;30:2312-20. https://doi.org/10.1097/01.brs.0000182315.88558.9c
  17. Yavin D, Casha S, Wiebe S, et al. Lumbar fusion for degenerative disease: a systematic review and metaanalysis. Neurosurgery 2017;80:701-15. https://doi.org/10.1093/neuros/nyw162
  18. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016;(1):CD010264.
  19. Ragab A, Deshazo RD. Management of back pain in patients with previous back surgery. Am J Med 2008;121:272-8. https://doi.org/10.1016/j.amjmed.2008.01.004
  20. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine (Phila Pa 1976) 2007;32:2119-26. https://doi.org/10.1097/BRS.0b013e318145a56a
  21. Chen JJ, Yang RK. A look inside an interdisciplinary spine center at an academic medical center. Iowa Orthop J 2008;28:98-101.
  22. McGirt MJ, Speroff T, Godil SS, Cheng JS, Selden NR, Asher AL. Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center. Neurosurg Focus 2013;34:E7.

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