“Spine Surgery Checklist”: A Step towards Perfection through Protocols

Abstract

Study Design: A retrospective study. Purpose: This study aimed to evaluate the effectiveness of a novel checklist that was designed specifically for the “spine-surgery-subspecialty” to reduce the incidence of some common preventable human errors and major perioperative complications in spine surgery. Overview of Literature: We propose a unique spine surgery-specific checklist that recognizes the risk factors, anticipates the possible human errors, and thus helps in preventing these errors. This checklist is associated with increased patient safety awareness, improved communication (keeps everyone updated regarding their responsibilities), reduction in the surgical claims, and reduction in the number of postoperative complications, including mortality. Methods: This retrospective pilot study was performed at single center on 858 spine surgery patients. The patients were divided into the following two groups: the study group (after implementation of the checklist [2016-2017]) and the control group (before the implementation of the checklist [2015-2016]). The incidence of common preventable human errors and major perioperative complications in spine surgeries were recorded and compared between the two groups. Results: The prevalence of wrong-level surgeries was 0%, and the overall prevalence of the preventable errors was 1.63% (7/428). The rate of adverse, near-miss, and no-harm events was 0.23% (1/428), 0.70% (3/428), and 0.70% (3/428), respectively. The preoperative, intraoperative, and postoperative errors were 0.70% (3/428), 0.23% (1/428), and 0.70% (3/428), respectively. The reoperation rate related to preventable errors reduced after the checklist was used. There were significant differences in the total preventable errors related to complications, such as infections, prolonged hospital stays, and unplanned hospital readmission/revision surgeries (p=0.001). Conclusions: The authors propose the first-of-its kind spine surgery-specific checklist that is comprehensive and involves perioperative parameters. The checklist is easy to use, safe, and effective for reducing the unforgiving errors and perioperative complications. However, its broader implementation would require validation in large, multi-center, randomized control studies.