Evaluating compliance with the best practice guidelines for wrong-level surgery prevention in high-risk pediatric spine surgery

Alondra Concepción-González; J Manuel Sarmiento; Christina C Rymond; Chinenye Ezeh; Rishi Sinha; Hannah Lin; Kevin Lu; Afrain Z Boby; Prakash Gorroochurn; A Noelle Larson; Benjamin D Roye; Brice Ilharreborde; Michael G Vitale; European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, Harms Study Group

doi:10.1007/s43390-024-00836-9

Evaluating compliance with the best practice guidelines for wrong-level surgery prevention in high-risk pediatric spine surgery

Spine Deform. 2024 Mar 21. doi: 10.1007/s43390-024-00836-9. Online ahead of print.

Authors

Alondra Concepción-González^{1

2}, J Manuel Sarmiento^{3

4}, Christina C Rymond³, Chinenye Ezeh⁴, Rishi Sinha⁵, Hannah Lin³, Kevin Lu³, Afrain Z Boby³, Prakash Gorroochurn⁶, A Noelle Larson⁷, Benjamin D Roye^{3

4}, Brice Ilharreborde⁸, Michael G Vitale^{3

4}; European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, Harms Study Group

Collaborators

European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, Harms Study Group:
Regina Wood, Michelle Marks, Carol Hasler, René Castelein, Sébastien Pesenta, Ilkka Helenius, Dror Ovadia, David Farrington, Muharrem Yazici, Moyo Kruyt, Jorge Mineiro, Oliana Madeira

Affiliations

¹ Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA. aconcepcion@gwu.edu.
² Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Alondra Concepción-González, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA. aconcepcion@gwu.edu.
³ Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.
⁴ Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA.
⁵ David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
⁶ Department of Biostatistics, Columbia University, New York, NY, USA.
⁷ Division of Pediatric Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55902, USA.
⁸ Pediatric Orthopaedic Department, Robert Debré Hospital, APHP, Cité University, Paris, Paris, France.

PMID: 38512566
DOI: 10.1007/s43390-024-00836-9

Abstract

Purpose: In 2018, Best Practice Guidelines (BPGs) were published for preventing wrong-level surgery in pediatric spinal deformity, but successful implementation has not been established. The purpose of this study was to evaluate BPG compliance 5 years after publication. We hypothesized higher compliance among BPG authors and among surgeons with more experience, higher caseload, and awareness of the BPGs.

Methods: We queried North American and European surgeons, authors and nonauthors, and members of pediatric spinal study groups on adherence to BPGs using an anonymous survey consisting of 18 Likert scale questions. Respondents provided years in practice, yearly caseload, and guideline awareness. Mean compliance scores (MCS) were developed by correlating Likert responses with MCS scores ("None of the time" = no compliance = MCS 0, "Sometimes" = weak to moderate = MCS 1, "Most of the time" = high = MCS 2, and "All the time" = perfect = MCS 3).

Results: Of the 134 respondents, 81.5% reported high or perfect compliance. Average MCS for all guidelines was 2.4 ± 0.4. North American and European surgeons showed no compliance differences (2.4 vs. 2.3, p = 0.07). Authors and nonauthors showed significantly different compliance scores (2.8 vs 2.4, p < 0.001), as did surgeons with and without knowledge of the BPGs (2.5 vs 2.2, p < 0.001). BPG awareness and compliance showed a moderate positive correlation (r = 0.48, p < 0.001), with non-significant associations between compliance and both years in practice (r = 0.41, p = 0.64) and yearly caseload (r = 0.02, p = 0.87).

Conclusion: Surgeons reported high or perfect compliance 81.5% of the time with BPGs for preventing wrong-level surgery. Authorship and BPG awareness showed increased compliance. Location, study group membership, years in practice, and yearly caseload did not affect compliance.

Level of evidence: Level V-expert opinion.

Keywords: Best practice guidelines; Compliance; Pediatric spinal deformity; Wrong-level surgery.