Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis.

Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis.

World Neurosurg. 2018 Jan 06;:

Authors: Adogwa O, Elsamadicy AA, Sergesketter AR, Ongele M, Vuong V, Khalid S, Moreno J, Cheng J, Karikari IO, Bagley CA

Abstract
OBJECTIVE: Interdisciplinary management of elderly patients requiring spine surgery has been shown to improve short and long-term outcomes. The aim of this study is to determine whether an interdisciplinary team approach mitigates use of intensive care unit (ICU) resources.
METHODS: A unique co-management model for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Peri-operative Optimization of Senior Health Program(POSH) was launched with the aim of improving outcomes in elderly patients(>65-years-old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients pre-operatively, co-manages daily throughout hospital course, and coordinate multidisciplinary rehabilitation, along with the neurosurgical team. We retrospectively review the first 100-cases after the initiation of the POSH-protocol and compared them with the immediately preceding 25-cases to assess the rates of ICU-transfer and independent predictors of ICU-admission.
RESULTS: 125 patients undergoing lumbar decompression and fusion surgery were enrolled in this pilot program. Baseline characteristics and intra-operative variables, as well as number of fusion levels and duration of surgery, were similar between both cohorts. There was a significant difference in the use of ICU services (ICU-admission-rates) between both cohorts, with Non-POSH cohort having a 3-fold increase compared to the POSH cohort(p<0.0001). In a multivariate analysis, lack of an interdisciplinary co-management team approach was an independent predictor for ICU transfers in elderly patients undergoing corrective surgery [OR: 8.51,95% CI(2.972, 24.37),p<0.0001].
CONCLUSIONS: Our study suggests that an interdisciplinary co-management model between geriatrics and neurosurgery is independently associated with reduced use of critical care services.

PMID: 29317368 [PubMed - as supplied by publisher]

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