Impact of a Quality Improvement Initiative and Monthly Multidisciplinary Meetings on Outcomes after Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Introduction: The aim of this study was to assess changes in intra- and postoperative outcomes following multidisciplinary team meeting implementation for patients undergoing PSIF for AIS.

Methods: The medical records of 179 adolescents (10 to 18 years old) diagnosed with AIS and undergoing PSIF at a major academic institution from 2013–2022 were retrospectively reviewed. A quality improvement (QI) initiative was implemented in February 2020, including institution of monthly multidisciplinary conferences focusing on preoperative indications, level selection, postoperative review of surgical performance parameters for previous cases, and discussion and optimization of postoperative ambulation and pain control protocols. Patients were placed into “Pre-QI” and “Post-QI” cohorts. Patient demographics, comorbidities, deformity characteristics, intraoperative variables, ambulation status, postoperative complications, length of stay (LOS), and unplanned readmission rates were assessed.

Results: Of the 179 study patients, 127 (70.9%) were in the Pre-QI cohort, and 52 (29.1%) were in the Post-QI cohort. The Pre-QI cohort had significantly greater mean major curve (p=0.025). The Pre-QI cohort had significantly greater mean spinal levels fused (Pre-QI: 12.09±1.48 vs Post-QI: 10.42±2.55,p < 0.001), significantly greater mean estimated blood loss (Pre-QI: 1066.73±493.40 ml vs. Post-QI: 415.77±189.86 ml,p < 0.001), and significantly greater mean operative time normalized to levels fused (Pre-QI: 0.57±0.14 hours/level fused vs Post-QI: 0.42±0.10 hours/level fused,p < 0.001). The Post-QI cohort had significantly shorter mean time to oral pain medications (Pre-QI: 2.28±0.66 days vs Post-QI: 2.06±1.14 days,p=0.006) and time to postoperative ambulation (Pre-QI: 2.50±0.83 days vs Post-QI: 1.29±0.46 days,p < 0.001). A significantly greater proportion of patients in the Pre-QI cohort developed any postoperative complication (Pre-QI: 74.0% vs Post-QI: 34.6%,p < 0.001), and mean LOS was significantly greater among Pre-QI patients (Pre-QI: 4.79±1.15 days vs Post-QI: 3.19±0.79 days,p < 0.001). Mean percentage of primary curve correction was significantly greater in the Post-QI cohort (Pre-QI: 72.74±9.96 vs Post-QI: 77.87±8.79,p=0.002).

Conclusion : Our findings suggest that monthly multidisciplinary pediatric spine team meetings may improve patient care. Further studies exploring the incorporation of QI implementation with frequent multidisciplinary team meetings into existing ERAS protocols are merited.