A study recently published in Spine examined how sentinel events in lumbar spine surgery impacts the quality and cost of care.
The study authors examined data from the Nationwide Inpatient Sample from 2002 to 2011 for patients who underwent lumbar spinal surgery. There were a total of $543,134 lumbar spine surgical procedures, with 414 patients who incurred sentinel events.
1. The most common sentinel event was wrong-site surgery, which occurred in 0.3 per 1,000 cases. Additional sentinel events included bowel or peritoneal injury, vascular injury, nerve injury and foreign object retention. A March 2014 study published in the Journal of Bone and Joint Surgery found up to 50 percent of neurosurgeons may perform wrong-level spine surgery at some point in their careers and the wrong level is typically the level cephalad to the intended level. Wrong-site surgery occurs despite adhering to the Universal Protocol.
2. The patient’s age and comorbidity burden showed no significant difference between the groups with and without sentinel events. A study published by AANS showed in 2012, there were 44 lawsuits brought against neurosurgeons, and wrong-level operations were the allegation in 13 percent; 75 percent said the “procedure “did not meet standard of care.” The verdict went in favor of the plaintiff in 16 percent of the cases and a settlement was reached in 20 percent. The average award for the plaintiff was $691,565 and the average reported settlement was $777,500.
3. Patients who had sentinel events reported longer hospitalization, greater costs and were more likely to experience in-hospital complications and mortality. The patients with bowel or peritoneal injury, vascular injury and wrong-site surgery had a greater risk of mortality. A 2012 study published in Spine examining the cost of major and minor spine complications found the cost of care was around $13,518 more for patients with complications. Cases with major complications were even more costly.
4. A survey of spine surgeons about wrong-site surgery shows around 74 percent of surgeons routinely obtain preoperative imaging for incision planning, and another 11 percent sometimes obtain the preoperative imaging. Most surgeons said they obtain imaging after the incision is made for localization before the bone is removed. While 50 percent reported performing wrong-site surgery at least once, only 40 percent of the survey respondents thought site marking and “time out” protocol from The Joint Commission on the Accreditation of Healthcare Organizations led to a reduction in these errors. The study was published by World Neurosurgery.
5. Complications are more common among Medicaid patients than privately-insured patients, according to a 2013 study in HealthDay News. Of about 1,600 patients examined in the study who underwent spine surgery, 23 percent were paid by Medicaid and 28 percent had private insurance. Initial analysis showed Medicaid patients had a 68 percent higher risk of complications. The researchers also found heart failure, bleeding disorders, trauma or infection could increase the risk of complications. The risk was also 111 times higher for patients who underwent the most invasive spine surgeries.
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