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Lin RT, Dalton JF, Como CJ, Chang AY, Tang MY, Oyekan AA, Sadhwani S, Wawrose RA, Lee JY, Shaw JD. Formal Radiologist Interpretations of Intraoperative Spine Radiographs Have Low Clinical Value. Spine (Phila Pa 1976) 2024; 49:933-940. [PMID: 38407343 DOI: 10.1097/brs.0000000000004973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To evaluate the clinical relevance, usefulness, and financial implications of intraoperative radiograph interpretation by radiologists in spine surgery. SUMMARY OF BACKGROUND DATA Due to rising health care costs, spine surgery is under scrutiny to maximize value-based care. Formal radiographic analysis remains a potential source of unnecessary health care costs, especially for intraoperative radiographs. MATERIALS AND METHODS A retrospective cohort analysis was performed on all adult elective spine surgeries at a single institution between July 2020 and July 2021. Demographic and radiographic data were collected, including intraoperative localization and post-instrumentation radiographs. Financial data were obtained through the institution's price estimator. Radiographic characteristics included time from radiographic imaging to completion of radiologist interpretation report, completion of radiologist interpretation report before the conclusion of surgical procedure, clinical relevance, and clinical usefulness. Reports were considered clinically relevant if the spinal level of the procedure was described and clinically useful if completed before the conclusion of the procedure and deemed clinically relevant. RESULTS Four hundred eighty-one intraoperative localization and post-instrumentation radiographs from 360 patients revealed a median delay of 128 minutes between imaging and completion of the interpretive report. Only 38.9% of reports were completed before the conclusion of surgery. There were 79.4% deemed clinically relevant and only 33.5% were clinically useful. Localization reports were completed more frequently before the conclusion of surgery (67.2% vs. 34.4%) but with lower clinical relevance (90.1% vs. 98.5%) and clinical usefulness (60.3% vs. 33.6%) than post-instrumentation reports. Each patient was charged $32 to $34 for the interpretation fee, cumulating a minimum total cost of $15,392. CONCLUSIONS Formal radiographic interpretation of intraoperative spine radiographs was of low clinical utility for spine surgeons. Institutions should consider optimizing radiology workflows to improve timeliness and clinical relevance or evaluate the necessity of reflexive consultation to radiology for intraoperative imaging interpretation to ensure that value-based care is maximized during spine surgeries. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Ryan T Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan F Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Christopher J Como
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Audrey Y Chang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Melissa Yunting Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Shaan Sadhwani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Richard A Wawrose
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
- Pittsburgh Orthopaedic Spine Research (POSR) Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Orthopaedic Surgery, Orland Bethel Family Musculoskeletal Research Center (BMRC), Pittsburgh, PA
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Kam JKT, Castle-Kirszbaum M, Dhaliwal T, Maingard J, Chandra R, Quan G, Gonzalvo CA, Goldschlager T. Preoperative coil localization for spinal surgery is accurate, safe and effective: a single-centre initial experience. ANZ J Surg 2024; 94:840-845. [PMID: 38553888 DOI: 10.1111/ans.18991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE AND STUDY DESIGN This is a retrospective, descriptive study of consecutive patients undergoing novel preoperative pushable coil localization for spinal surgery, in order to evaluate its feasibility, safety and accuracy. METHODS Consecutive patients who underwent pre-operative coil marking for spinal surgery at our institution from May 2018 to July 2021 were included. Data were collected for coil placement, accuracy, complications and fluoroscopy usage. Patient demographic and relevant perioperative and procedural data were also collected. RESULTS A total of 34 patients were identified of which 32 (94%) had complete data and imaging at last clinical follow up, with a mean duration of 13.9 months. There were no incorrect level surgeries performed. There were no coil-related complications found in our cohort. CONCLUSIONS Preoperative coil placement is an accurate, safe and well-tolerated method for level localization in spinal surgeries.
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Affiliation(s)
- Jeremy K T Kam
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | | | | | - Julian Maingard
- Department of Radiology, Monash Health, Melbourne, Australia
| | - Ronil Chandra
- Department of Radiology, Monash Health, Melbourne, Australia
| | - Gerald Quan
- Department of Orthopaedics and Neurosurgery, Austin Health, Melbourne, Australia
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Saito R, Fujibayashi S, Shimizu T, Murata K, Otsuki B, Onishi E, Matsuda S, Yasuda T. Wrong-level spine surgery: A multicenter retrospective study. J Orthop Sci 2023:S0949-2658(23)00319-6. [PMID: 37996298 DOI: 10.1016/j.jos.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Wrong-level spine surgery is a rare but serious complication of spinal surgery that increases patient harm and legal risks. Although such surgeries have been reported by many spine surgeons, they have not been adequately investigated. Therefore, this study aimed to examine the causes and preventive measures for wrong-level spine surgeries. METHODS This study analyzed cases of wrong-level spine surgeries from 10 medical centers. Factors such as age, sex, body mass index, preoperative diagnosis, surgical details, surgeon's experience, anatomical variations, responses, and causes of the wrong-level spine surgeries were studied. The methods used by the surgeons to confirm the surgical level were also surveyed using a questionnaire for each surgical procedure and site. RESULTS Eighteen cases (13 men and 5 women; mean age, 61.2 years; mean body mass index, 24.5 kg/m2) of wrong-level spine surgeries were evaluated in the study. Two cases involved emergency surgeries, three involved newly introduced procedures, and five showed anatomical variations. Wrong-level spine surgeries occurred more frequently in patients who underwent posterior thoracic surgery than in those who underwent other techniques (p < 0.01). Twenty-two spinal surgeons described the methods used to confirm the levels preoperatively and intraoperatively. In posterior thoracic laminectomies, half of the surgeons used preoperative markers to confirm the surgical level and did not perform intraoperative fluoroscopy. In posterior thoracic fusion, all surgeons confirmed the level using fluoroscopy preoperatively and intraoperatively. CONCLUSIONS Wrong-level spine surgeries occurred more frequently in posterior thoracic surgeries. The thoracic spine lacks the anatomical characteristics observed in the cervical and lumbar spine. The large drop in the spinous process can make it challenging for surgeons to determine the positional relationship between the spinous process and the vertebral body. Moreover, unfamiliarity with the technique and anatomical variations were also risk factors for wrong-level spine surgeries.
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Affiliation(s)
- Ryohei Saito
- Kobe City Medical Center General Hospital, Orthopedic Surgery, Hyogo, Japan; Kyoto University Hospital, Orthopedic Surgery, Kyoto, Japan.
| | | | | | - Koichi Murata
- Kyoto University Hospital, Orthopedic Surgery, Kyoto, Japan
| | - Bungo Otsuki
- Kyoto University Hospital, Orthopedic Surgery, Kyoto, Japan
| | - Eijiro Onishi
- Kobe City Medical Center General Hospital, Orthopedic Surgery, Hyogo, Japan
| | | | - Tadashi Yasuda
- Kobe City Medical Center General Hospital, Orthopedic Surgery, Hyogo, Japan
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Lepard JR, Yaeger K, Mazzola C, Stacy J, Shuer L, Kimmel K. Mechanisms of Peer Review and Their Potential Impact on Neurosurgeons: A Pilot Survey. World Neurosurg 2022; 167:e469-e474. [PMID: 35973519 DOI: 10.1016/j.wneu.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physician peer review is a universal practice in U.S. hospitals. While there are many commonalities in peer review procedures, many of them established by law, there is also much institutional variation, which should be well understood by practicing neurosurgeons. METHODS A 13-question pilot survey was conducted of a sample of 5 hospital systems with whom members of the Council of State Neurosurgical Societies Medico-Legal Committee are affiliated. Survey questions were constructed to qualitatively assess 3 features of hospital peer review: 1) committee composition and process, 2) committee outcomes, and 3) legal protections and ramifications. RESULTS The most common paradigm for a physician peer review committee was an interdisciplinary group with representatives from most major medical and surgical subspecialties. Referrals for peer review inquiry could be made by any hospital employee and were largely anonymous. Most institutions included a precommittee screening process conducted by the physician peer review committee leadership. The most common outcomes of an inquiry were resolution with no further action or ongoing focused professional practice evaluation. Hospital privileges were only rarely reported to be revoked or terminated. Members of the physician peer review committee were consistently protected from retaliatory litigation related to peer review participation. Most hospitals had a multilayered decision process and availability of appeal to minimize potential for punitive investigations. CONCLUSIONS According to a recent study, only 62% of hospitals consider their peer review process to be highly or significantly standardized. This pilot survey provides commentary of potential areas of commonality and variation among hospital peer review practices.
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Affiliation(s)
- Jacob R Lepard
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Kurt Yaeger
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - Catherine Mazzola
- Division of Pediatric Neurological Surgery, New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey, USA
| | - Jason Stacy
- Division of Neurosurgery, North Mississippi Medical Center, Tupelo, Mississippi, USA
| | - Lawrence Shuer
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kristopher Kimmel
- Department of Neurosurgery, Rochester Regional Health, Rochester, New York, USA
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Hafez AT, Omar I, Purushothaman B, Michla Y, Mahawar K. Never events in orthopaedics: A nationwide data analysis and guidance on preventative measures. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 33:319-332. [PMID: 34486990 DOI: 10.3233/jrs-210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties. OBJECTIVE The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England. METHOD We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes. RESULTS We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest "wrong implants" (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 "Wrong-site surgery" incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each. CONCLUSION We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a Real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while Fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.
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Affiliation(s)
- Ahmed T Hafez
- Royal London Hospital, Barts Health NHS Trust, Shadwell, London, UK
| | - Islam Omar
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Balaji Purushothaman
- Department of Trauma and Orthopaedic Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Yusuf Michla
- Department of Trauma and Orthopaedic Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Kamal Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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