Quality, Safety, and Value of Innovating Classic Operative Techniques in Scoliosis Surgery: Intraoperative Traction and Navigated Sequential Drilling.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: This study aims to measure and describe the clinical and financial implications of the systematic implementation of intraoperative skull-femoral traction (IOSFT) and navigated sequential drilling (NSD) for posterior spinal instrumentation and fusion (PSIF) in adolescent idiopathic scoliosis (AIS) at our institution. SUMMARY OF BACKGROUND DATA: PSIF has been the standard surgical treatment for AIS. This retrospective single-center quality improvement study describes the perioperative outcomes and impact on health resource utilization following the systematic application of two classic surgical strategies modified using current technology: IOSFT and NSD. METHODS: We reviewed the medical records of 125 patients who underwent a single-stage PSIF for AIS. We identified three cohorts based on surgical strategies used intraoperatively. Traditional techniques (n = 28), IOSFT (n = 45), and IOSFT plus NSD (n = 52). The primary outcome measures were operative time, prevalence of cases requiring extended operating room time, need for blood transfusion, length of hospital stay, and cost per surgery. Secondary outcomes included implant density, degree of spine deformity correction, and perioperative complications. RESULTS: All primary outcome measures improved significantly (p < .001). Median operating time decreased by 59%. Use of late operating room hours fell from 89% to 0% and transfusion rates from 64% to 1.9%. Length of hospital stay decreased from 6 to 4 days. Comprehensive cost per case decreased by 24%. DISCUSSION: Together, IOSFT and NSD improved the quality, safety, and value of care. These surgical strategies were performed without increased perioperative complications, while reducing cost per case by 24%. CONCLUSIONS: The data presented may have significant implications in health resource utilization for AIS surgery. LEVEL OF EVIDENCE: Level III.

Intraoperative skull-femoral traction in posterior spinal arthrodesis for adolescent idiopathic scoliosis: the impact on perioperative outcomes and health resource utilization.

STUDY DESIGN: Retrospective, single-center cohort study. OBJECTIVE: To study how the systematic use of intraoperative skull-femoral traction (IOSFT) in posterior arthrodesis for adolescent idiopathic scoliosis impacts perioperative outcomes and health resource utilization. SUMMARY OF BACKGROUND DATA: Large scoliosis curves have been associated with increased morbidity and utilization of health resources. When used with reliable neurophysiological monitoring, IOSFT has shown to be safe and to reduce curve magnitude intraoperatively. Thus, we hypothesized that the systematic use of IOSFT may contribute to reducing health resource utilization by reducing curve magnitudes intraoperatively. METHODS: Seventy-three consecutive patients with adolescent idiopathic scoliosis who underwent single-stage posterior spinal arthrodesis from 2008 to 2012 at a tertiary children's hospital were identified. Forty-five patients were operated with IOSFT (traction group) and 28 patients were operated without IOSFT (nontraction group). Outcome measures included operative time, calculated blood loss, blood transfusion requirement, traction-related complications, and cost comparisons. RESULTS: Operative time was 375.6 minutes for the traction group (P=0.0001) and 447.6 minutes for the nontraction group. Calculated blood loss was significantly less in the traction group (P=0.027). Thirty-three percent of patients in the traction group required blood transfusion compared with 64% of patients in the nontraction group (P=0.01, absolute risk reduction of 31%). There was no significant difference in curve magnitude correction (P=0.49). There were no significant complications with the use of traction. There was a significant reduction in cost per surgical procedure in the traction group (P=0.0003). CONCLUSION: The systematic use of IOSFT in posterior spinal arthrodesis for adolescent idiopathic scoliosis contributed to significant reductions in health resource utilization, with no added morbidity. Further research is warranted to investigate the generalizability of these findings. LEVEL OF EVIDENCE: 4.