While spine and orthopedic surgeons may be prepared to execute flawless operations for their patients on surgery day, several other factors can determine whether a surgery is successful.
Several social determinants, including access to food, follow-up care and even family, have an impact on surgery success, even if a procedure is executed perfectly.
Daniel Sciubba, MD, senior vice president of neurosurgery at Northwell and co-executive director of the Northwell Spine Institute based in New Hyde Park, N.Y., spoke with Becker's about how Northwell is taking steps to ensure that patients are as prepared for their operations as possible.
Dr. Sciubba: I think that obviously always a practice goal is to become a better surgeon and make surgery safer and more effective. What I am more excited about now, though, is that what surgery involves is more than just time of surgery. We're seeing that meeting the patients where they are and where their strains are is more important for outcomes. The social determinants of health. What we know is that if a person cannot speak English or does not have wealth or access, that will predict health more than surgery. If that's true, then our surgery has to be expanded so they don't just have surgery, but they have appropriate precare and post-care. Before and after surgery. If a patient isn't prepped ideally, if they don't get prehab or maximum medical management to get them prepared, and if afterwards we abandon them, that surgery will be evaluated with a bad score. That person will be unhappy and not do well and you'll say, "Well, I did a really good surgery, what happened?" It's not just that day. It's like going to a fancy dinner. If you have trouble getting there or you get in a car wreck on the way there, you'll say, "Well, it was OK, even if the food was great." If you had a bad experience, it's bad. We are working on managing pain even before skin incisions. How do we deal with phone calls from family, how do we deal with, when patients are home, how are they getting back to the office. As we integrate day of surgery into week of surgery, month of surgery, we're learning that it matters with how patients recover.
Pain medications before and after to avoid narcotic use are critical. If we can give patients pain management before surgery that's not narcotic-based, patients have a better time after surgery and don't need the big guns. In 2025 and beyond, if we compare someone with a surgery this year to someone with a surgery in 2020, they'll say, "Wow! It was a shorter hospital stay, I went back to work sooner and they treated me with where I am in my life and with my resources and it was a better experience." If we do that, we will take better care of each other. That's what I look forward to. I am currently unhappy with how patients do in my hands in many ways. Every day, I wish that things could've been faster, smoother, I wish that patients could have had a better experience. We're not just a solo artist for a few hours when in the room, we're part of a whole team experience. We look at this now as a team approach. Family is part of the team, spouses, children, nurses, pharmacists, clergy, are part of the team that help give patients better surgery. And a lot of people are codifying this, it isn't just talk. Next thing you know, the patient says they had a really good experience because you leveraged all the resources and added resources for them. If you don't have what it takes to make it through a big surgery, you'll have bad outcomes.