Barkyoumb David, Kaiser William C, Smith Lonnie, Villeneuve Lance M, Mulvaney Graham, Li Chao, Graffeo Christopher S, Bauer Andrew M, Shakir Hakeem J, Balsara Karl, Janjua M Burhan, Burke John F, Jea Andrew, Smith Zachary A
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Vanderbilt University, Nashville, TN, USA.
Geroscience. 2025 Aug 13. doi: 10.1007/s11357-025-01826-z.
Standardized care delivery protocols have demonstrated substantial benefits across a range of surgical subspecialties, with growing evidence supporting their application to elective spinal surgery. At our institution, we have developed and implemented a comprehensive spine surgery protocol that spans both the ambulatory and inpatient phases of care. In this manuscript, we focus on our inpatient protocol, which incorporates a standardized checklist designed to reduce surgical morbidity and enhance patient outcomes. Key areas of focus include mitigation of surgical site infections, wound complications, decreasing opioid use and dependency, and accelerating functional recovery. Each intervention has been selected and is based upon evidence from the literature, clinical relevance, and feasibility, and is applied systematically across each phase of care: pre-incision, intraoperative, and postoperative phases. While the protocol is currently being piloted among high-risk patients, it is designed for future scalability and institution-wide integration. Importantly, although focused on the inpatient surgical episode, this portion of the protocol's benefits extends beyond hospitalization. By targeting the modifiable risk factors most closely associated with postoperative complications and readmissions, this protocol has the potential to reduce healthcare utilization and improve long-term outcomes. In doing so, it contributes meaningfully to the growing body of literature supporting standardized care protocols as a critical tool in delivering high-value, outcome-driven spine care.
标准化的护理交付协议已在一系列外科亚专业中显示出显著益处，越来越多的证据支持将其应用于择期脊柱手术。在我们机构，我们制定并实施了一项全面的脊柱手术协议，该协议涵盖了门诊和住院护理阶段。在本手稿中，我们重点关注我们的住院协议，该协议包含一个标准化检查表，旨在降低手术发病率并改善患者预后。重点关注的关键领域包括减轻手术部位感染、伤口并发症、减少阿片类药物使用和依赖，以及加速功能恢复。每项干预措施均基于文献证据、临床相关性和可行性进行选择，并在护理的每个阶段（术前、术中和术后）系统应用。虽然该协议目前正在高危患者中进行试点，但它旨在未来实现可扩展性和全院整合。重要的是，尽管该协议侧重于住院手术阶段，但其这部分益处超出了住院范围。通过针对与术后并发症和再入院密切相关的可改变风险因素，该协议有可能减少医疗保健利用并改善长期预后。这样做，它对越来越多支持标准化护理协议作为提供高价值、以结果为导向的脊柱护理关键工具的文献做出了有意义的贡献。
