gms | German Medical Science

Objectives: Wrong level operations are unique to spine surgery and fall under the wrong-site surgery sentinel events reporting system by the patient safety network and the AHQR (Agency for Healthcare Research and Quality). While relatively rare these are undesirable events. The purpose of this survey is to determine what factors are deemed the most important in preventing wrong-site spine surgery amongst full time spine surgeons and advanced trainees. Our intention is to catalyze discussion on the most effective means and develop protocols to ideally prevent wrong level surgery.

Methods: A survey was created that included one question to assess consensus on the single greatest factor contributing to wrong-site surgery; nine yes-no questions to assess opinions on the utility of various methods to reduce wrong-site surgery; and one question rank ordering the importance of various methods for reducing wrong-site surgery. The survey was disseminated between February and May 2017 to spine surgery faculty and trainees. Descriptive statistics were used to characterize the responses. Proportions were calculated and stratified by faculty and trainees for the first 10 questions. For the last question, we used the midpoint of 5 on a 1 to 9 scale to determine the most helpful measures for reducing wrong site surgery as judged by faculty and trainees. Those measures that had a mean rank less than 5 were considered most helpful and those with a mean rank higher than the rank of 5 were considered least helpful.

Results and conclusion: Thirty questionnaires (fellows n=16; faculty n=14) were completed and returned to the investigators. A thoracic spine lesion without osseous landmarks was the single greatest factor in wrong-site surgery for the faculty (46.7%) and the trainees (66.7%). Overall classified, as the most helpful tool was a "more concise side specific consent language" in 93.3%. A "routine use of CT to include C7 and L1 in addition to MRI for thoracic soft tissue lesions", a "radiologists flagging readings on spine for segmentation anomalies" and use of a "level labeled CT scan following myelograms" was classified as "helpful" in 93.3% by the trainees. The most helpful measure for reducing wrong-site surgery as judged by faculty was an "intraoperative 3D CT fluoroscopy" (2.6 ± 1.9) and a "routine expanded CT for thoracic spine surgery" (3.4 ± 2.1) as judged by the advanced trainees. As least "helpful" classified by the fellows was a "post-operative marked fluoroscopy" (7.1 ± 2.3).

This study could show that faculty and trainees differ in their assessment in how to prevent wrong level spine surgery. Never less, both found routine expanded CT, a labeled CT with target and a more concise side specific consent language to be the effective countermeasures. Intraoperative imaging may be particularly challenging with patients who have decreased bone density or are clinically obese. Especially in thoracic spine lesion without osseous landmarks extreme caution is necessary to prevent wrong level surgery.