Differences in Perioperative Management of Patients Undergoing Complex Spine Surgery: A Global Perspective

Samuel N. Blacker, Nathan Woody, Ananya Abate Shiferaw, Mark Burbridge, Maria A. Bustillo, Sprague W. Hazard, Benjamin J. Heller, Massimo Lamperti, Jorge Mejia-Mantilla, Jacob W. Nadler, Girija Prasad Rath, Chiara Robba, Anita Vincent, Azarias K. Admasu, Meron Awraris, Abhijit V. Lele

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Background: The aim of this survey was to understand institutional spine surgery practices and their concordance with published best practices/recommendations. Methods: Using a global internet-based survey examining perioperative spine surgery practice, reported institutional spine pathway elements (n=139) were compared with the level of evidence published in guideline recommendations. The concordance of clinical practice with guidelines was categorized as poor (≤20%), fair (21%-40%), moderate (41%-60%), good (61%-80%), or very good (81%-100%). Results: Seventy-two of 409 (17.6%) institutional contacts started the survey, of which 31 (7.6%) completed the survey. Six (19.4%) of the completed surveys were from respondents in low/middle-income countries, and 25 (80.6%) were from respondents in high-income countries. Forty-one incomplete surveys were not included in the final analysis, as most were less than 40% complete. Five of 139 (3.6%) reported elements had very good concordance for the entire cohort; hospitals with spine surgery pathways reported 18 elements with very good concordance, whereas institutions without spine surgery pathways reported only 1 element with very good concordance. Reported spine pathways included between 7 and 47 separate pathway elements. There were 87 unique elements in the reviewed pathways. Only 3 of 87 (3.4%) elements with high-quality evidence demonstrated very good practice concordance. Conclusions: This global survey-based study identified practice variation and low adoption rates of high-quality evidence in the care of patients undergoing complex spine surgery.

Original languageEnglish (US)
Pages (from-to)218-227
Number of pages10
JournalJournal of Neurosurgical Anesthesiology
Issue number3
StatePublished - Jul 1 2024

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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