Key result
A postoperative quality improvement care bundle significantly reduced the annual incidence of cardiac, pulmonary, nausea, and medication-related adverse events by 7.8% to 15.0% (p < 0.01).
Why the study?
Does a postoperative quality improvement care bundle reduce postoperative medical adverse events in adult surgical spine patients?
Observational (n=13,493)
Does a postoperative quality improvement care bundle reduce postoperative medical adverse events in adult surgical spine patients?
p-value: p=<0.01
Implementation of a postoperative quality improvement care bundle significantly reduced the incidence of specific medical adverse events and resulted in substantial projected cost savings in adult spine surgery patients.
QI bundle was associated with fewer select AEs and projected savings after spine surgery; leaves open need for randomized trials before broad adoption.
BACKGROUND AND OBJECTIVES: Spine surgery is associated with a high incidence of postoperative medical adverse events (AEs). Many of these events are considered "minor" though their cost and effect on outcome may be underestimated. We sought to examine the clinical and cost-effectiveness of a postoperative quality improvement (QI) care bundle in mitigating postoperative medical AEs in adult surgical spine patients. METHODS: We collected 14-year prospective observational interrupted time series (ITS) with two historical cohorts: 2006 to 2008, pre-implementation of the postoperative QI care bundle; and 2009 to 2019, post-implementation of the postoperative QI care bundle. Adverse Events were identified and graded (Minor I and II) using the previously validated Spine AdVerse Events Severity (SAVES) system. Pearson Correlation tested for changes across patient and surgical variables. Adjusted segmented regression estimated the effect of the postoperative QI care bundle on the annual and absolute incidences of medical AEs between the two periods. A cost model estimated the annual cumulative cost savings through preventing these "minor" medical AEs. RESULTS: We included 13,493 patients over the study period with a mean of 964 per year (SD ± 73). Mean age, mean Charlson Comorbidity Index (CCI), and mean spine surgical invasiveness index (SSII) increased from 48.4 to 58.1 years; 1.7 to 2.6; and 15.4 to 20.5, respectively (p < 0.001). Unadjusted analysis confirmed a significant decrease in the annual number of all medical AEs (p < 0.01). When adjusting for age, CCI and SSII, segmented regression demonstrated a significant absolute reduction in the annual incidence of cardiac, pulmonary, nausea and medication-related AEs by 9.58%, 7.82%, 11.25% and 15.01%, respectively (p < 0.01). The postoperative QI care bundle was not associated with reducing the annual incidence of delirium, electrolyte levels or GI AEs. Annual projected cost savings for preventing Grade I and II medical AEs were $1,808,300 CAD and $11,961,500 CAD. CONCLUSION: Postoperative QI care bundles are effective for improving patient care and preventing medical care-related AEs, with significant cost savings. Postoperative QI care bundles should be tailored to the specific vulnerability of the surgical population for experiencing AEs.
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Moskven et al. (2024) conducted an observational in Spine surgery (n=13,493). Postoperative quality improvement (QI) care bundle vs. Pre-implementation cohort (2006-2008) was evaluated on Annual and absolute incidences of medical adverse events (p=<0.01). A postoperative quality improvement care bundle significantly reduced the annual incidence of cardiac, pulmonary, nausea, and medication-related adverse events by 7.8% to 15.0% (p < 0.01).
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