The introduction of a Neurosurgical Postoperative Checklist improved quality of care and patient safety.

Purpose: Neurosurgical patients are often complex and require high quality, attentive care in the immediate postoperative period. We identified a number of issues in our department pertaining to patient safety and the assessment and management of patients following handover of care to the neurosurgical ward, and intervened with an aim to provide safe, timely, patient-centred, and procedure-specific care in the postoperative period. Method: We reviewed the records of 50 patients between (Aug-Oct 2015) and analysed quality of postoperative assessment, prescriptions, and adherence to national standards of postoperative care. We identified barriers to effective practice and intervened by introducing a bespoke Neurosurgical Postoperative Checklist which provided a framework for the assessment and management of patients in the immediate postoperative period. We reviewed the records of 50 patients (Oct-Nov 2016) to assess adherence to the new protocol and its effect on the quality of postoperative care, and reaudited a further 50 patients after one year (Sep-Nov 2016). Results: Prior to intervention 37/50 (74.0%) patients were reviewed postoperatively and quality was poor. This improved to 49/50 (98.0%) post-Checklist and was associated with a dramatic improvement in quality of care compared to pre-Checklist: appropriate analgesia and anti-emetics prescribed in 98.0% and 98.0% versus 26.0% and 18.0%; appropriate antibiotic and corticosteroid prescription in 100.0% and 100.0% versus 26.0% and 18.0%; and timely prescription of an appropriate VTE prophylaxis plan in 98.0% versus 2.0% pre-Checklist. Improvements were sustained after one year. Conclusions: The introduction of our Neurosurgery Postoperative Checklist yielded dramatic improvements in patient safety and quality of postoperative care, as indicated by improved adherence to national standards of postoperative clinical assessment, and the quality and safety of medication prescriptions which are so vital in complex neurosurgical patients. We recommend the use of a neurosurgical Postoperative Checklist as a simple, cheap, reproducible tool to improve patient care.

Pre-operative obesity does not predict poorer symptom control and quality of life after lumbar disc surgery.

PURPOSE: We aimed to determine whether there was a difference in post-operative symptomatic control and quality of life (QoL) between patients who were obese (BMI >30) and non-obese (BMI <30) pre-operatively. This information may inform the decision making of Physicians and patients whether to proceed to surgery for management of symptomatic lumbar disc prolapse. METHODS: We conducted a prospective questionnaire-based study of QoL and symptom control in 120 patients with postal follow-up at 3 and 12 months after lumbar disc surgery. This study was conducted in two United Kingdom regional neurosurgical units, with ethical approval from the North of Scotland Research Ethics Service (09/S0801/7). RESULTS: 120 patients were recruited; 37 (34.5%) were obese. Follow up was 71% at 3 months and 57% at 12 months. At recruitment, both obese and non-obese patient groups had similar functional status and pain scores. At 3 and 12 months, non-obese and obese patients reported similar and significant benefits from surgery (e.g. 12 month SF-36 80.5 vs. 68.8, respectively). In non-obese and obese patients, time to return to work was 47.5 days and 53.8 days, respectively, (p = .345). After 12 months all QoL scores were significantly improved from pre-operative levels in both groups. CONCLUSIONS: Obese patients derive significant benefit from lumbar discectomy that it is similar to the benefit experienced by non-obese patients. Obese individuals may achieve excellent results from discectomy and these patients should not be refused surgery on the basis of BMI alone.