Vitale Michael, Minkara Anas, Matsumoto Hiroko, Albert Todd, Anderson Richard, Angevine Peter, Buckland Aaron, Cho Samuel, Cunningham Matthew, Errico Thomas, Fischer Charla, Kim Han Jo, Lehman Ronald, Lonner Baron, Passias Peter, Protopsaltis Themistocles, Schwab Frank, Lenke Lawrence
Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA.
Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA.
Spine Deform. 2018 Mar-Apr;6(2):121-129. doi: 10.1016/j.jspd.2017.08.005. Epub 2017 Oct 18.
Consensus-building using the Delphi and nominal group technique.
To establish best practice guidelines using formal techniques of consensus building among a group of experienced spinal deformity surgeons to avert wrong-level spinal deformity surgery.
Numerous previous studies have demonstrated that wrong-level spinal deformity occurs at a substantial rate, with more than half of all spine surgeons reporting direct or indirect experience operating on the wrong levels. Nevertheless, currently, guidelines to avert wrong-level spinal deformity surgery have not been developed.
The Delphi process and nominal group technique were used to formally derive consensus among 16 fellowship-trained spine surgeons. Surgeons were surveyed for current practices, presented with the results of a systematic review, and asked to vote anonymously for or against item inclusion during three iterative rounds. Agreement of 80% or higher was considered consensus. Items near consensus (70% to 80% agreement) were probed in detail using the nominal group technique in a facilitated group meeting.
Participants had a mean of 13.4 years of practice (range: 2-32 years) and 103.1 (range: 50-250) annual spinal deformity surgeries, with a combined total of 24,200 procedures. Consensus was reached for the creation of best practice guidelines (BPGs) consisting of 17 interventions to avert wrong-level surgery. A final checklist consisting of preoperative and intraoperative methods, including standardized vertebral-level counting and optimal imaging criteria, was supported by 100% of participants.
We developed consensus-based best practice guidelines for the prevention of wrong-vertebral-level surgery. This can serve as a tool to reduce the variability in preoperative and intraoperative practices and guide research regarding the effectiveness of such interventions on the incidence of wrong-level surgery.
Level V.
采用德尔菲法和名义群体技术达成共识。
通过在一组经验丰富的脊柱畸形外科医生中运用正式的共识达成技术，制定最佳实践指南，以避免脊柱畸形手术错误节段。
此前众多研究表明，脊柱畸形手术错误节段的发生率相当高，超过半数的脊柱外科医生报告有过直接或间接在错误节段进行手术的经历。然而，目前尚未制定出避免脊柱畸形手术错误节段的指南。
运用德尔菲法和名义群体技术，在16名接受过专科培训的脊柱外科医生中正式达成共识。对医生们的当前实践进行调查，向他们展示一项系统评价的结果，并要求他们在三轮迭代过程中对项目纳入与否进行匿名投票。80%或更高的一致性被视为达成共识。对于接近共识（70%至80%的一致性）的项目，在一次有主持人的小组会议中使用名义群体技术进行详细探讨。
参与者的平均从业年限为13.4年（范围：2至32年），每年平均进行103.1例（范围：50至250例）脊柱畸形手术，总计实施了24200例手术。就制定由17项避免手术错误节段的干预措施组成的最佳实践指南达成了共识。一份包含术前和术中方法的最终清单，包括标准化的椎体节段计数和最佳影像学标准，得到了100%参与者的支持。
我们制定了基于共识的预防脊柱手术错误节段的最佳实践指南。这可作为一种工具，减少术前和术中实践的差异，并指导关于此类干预措施对手术错误节段发生率有效性的研究。
V级。
