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Does a dedicated “Scoliosis Team” and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?

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Abstract

Purpose

The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions.

Methods

A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal–Wallis, and χ2 tests were used.

Results

500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing.

Conclusion

Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.

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Data availability

Datasets generated and analyzed during the current are not publicly available, but are available from the corresponding author on reasonable request.

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Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen Children’s Medical Center, Northwell Hofstra School of Medicine, 7 Vermont Drive, Lake Success, New Hyde Park, NY, 11042, USA

    Vishal Sarwahi, Sayyida Hasan, Keshin Visahan, Stephen Wendolowski, Rushabh Vora, Jesse Galina, Terry Amaral & Jon-Paul DiMauro

  2. New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA

    Himanshu Rao

  3. New York Medical College, Valhalla, NY, USA

    Matan Grunfeld

  4. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Peter Dzaugis

  5. Albert Einstein College of Medicine, Bronx, NY, USA

    Yungtai Lo

  6. Montefiore Medical Center, Bronx, NY, USA

    Marina Moguilevitch & Beverly Thornhill

Authors
  1. Vishal Sarwahi
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  2. Sayyida Hasan
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  3. Himanshu Rao
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  4. Keshin Visahan
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  5. Matan Grunfeld
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  6. Peter Dzaugis
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  7. Stephen Wendolowski
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  8. Rushabh Vora
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  9. Jesse Galina
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  10. Yungtai Lo
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  11. Marina Moguilevitch
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  12. Beverly Thornhill
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  13. Terry Amaral
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  14. Jon-Paul DiMauro
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Contributions

Conceptualization: VS, SH, TA, J-PDM. Methodology: VS, SH, YL, MM, BT, TA, J-PDM. Formal analysis and investigation: SH, HR, KV, MG, PD, SW, RV, JG, YL. Writing—original draft preparation: SH, HR, SW. Writing—reviewing and editing: VS, SH, HR, KV, MG, PD, SW, RV, JG, TA, J-PDM. Supervision: VS, MM, BT, TA, J-PDM. Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data: all authors. Drafted the work or revised it critically for important intellectual content: all authors. Approved the version to be published: all authors. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

Corresponding author

Correspondence to Vishal Sarwahi.

Ethics declarations

Conflict of interest

Dr. Sarwahi received personal fees from Medical Device Business Services, INC., Depuy Synthes, INC., Precision Spine, INC., and Nuvasive, INC., outside the submitted work. All other authors declare that they have no relevant financial or non-financial interests and no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Northwell Health who determined that our study did not need ethical approval. An official waiver of ethical approval was granted from the IRB of Northwell Health.

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Sarwahi, V., Hasan, S., Rao, H. et al. Does a dedicated “Scoliosis Team” and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?. Spine Deform 11, 1409–1418 (2023). https://doi.org/10.1007/s43390-023-00728-4

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  • DOI: https://doi.org/10.1007/s43390-023-00728-4

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