The Impact of Standardized Operating Room Process versus Dedicated Team on Outcomes in Pediatric Spinal Deformity Surgery.

Abstract

Retrospective chart review. The objective of this study was to identify and compare the effectiveness of a regularized operating room (OR) process versus utilization of a consistent "scoliosis team" for improving outcomes associated with pediatric spinal deformity surgery. Operating room (OR) standardization has garnered significant attention as a critical strategy for enhancing surgical safety and outcomes. The benefits of OR standardization are significant in complex surgical fields. Previous studies have shown that standardized care protocols can decrease surgical time and costs for spine surgeries. Maintaining a dedicated team can be difficult, but a process can be easily implemented at most institutions. Patients operated on during the study period were divided into two groups based on the type of standardization applied: the dedicated Team group (2018-2022) and the standardized Process group (2023-2024). The dedicated Team group included surgeries performed by a consistent team of OR staff, all following the standardized surgical process. The standardized process divides the surgical procedure into three phases: exposure, screw insertion, and correction. This process reduces the number of trays and instruments required. The Process group was formed in 2023, when new ORs did not maintain a dedicated team. Surgical time (224 minutes vs. 260 minutes; P<0.001) and LOS (3 days vs. 4 days; P<0.001) were significantly lower for Process compared to Team. Total morphine consumption (123.0 mg vs. 132.2 mg; P=0.028) and OR costs ($10,819 vs. $12,558; P<0.001) were also significantly lower for Process. 30-day and 90-day complication rates were not significant between the groups (P=0.71; P=0.43). A complex procedure like posterior spinal fusion can be standardized in a manner that can invite more staff to participate. Based on the results of this study, a standardized process alone can be beneficial in improving patient outcomes.