Quality and safety improvement initiatives in complex spine surgery

The global health policy landscape is shifting. Health care is moving toward a value-based system with emphasis on reduced adverse events, improved patient outcomes, and increased cost efficiency. Studies have demonstrated that complex adult lumbar scoliosis surgery is accompanied by high variability in complication rates, which may be prevented with improved delivery of evidence-based care. In particular, standardized, systematic, multidisciplinary perioperative care protocols have been shown to significantly reduce the likelihood of a spectrum of negative outcomes associated with complex adult lumbar scoliosis surgery. This paper presents a review and analysis of multiple quality and safety improvement initiatives and methodologies in adult complex spine surgery. Achieving maximal quality and safety improvements in this field appears to require clinicians to go beyond focusing on specific elements of clinical practice and pay attention to optimizing the perioperative system. Two novel conceptual models were developed: the SpineSIM-D and the SpineSIM-C. They synthesize key success factors operating at the individual, team, and organizational levels to guide future quality and safety improvement initiatives. Comprehensive, systematic perioperative protocols that are multidisciplinary in nature appear to be rare in the field of complex spine surgery and have the potential to further improve quality and safety thereby meeting the requirements of health care's value-driven future.