A significant gap in spine surgery safety awareness struck Michael Vitale, MD MPH, of New York City-based NewYork-Presbyterian/Columbia Orthopedics, in 2012.
Although physicians fiercely respect their oath to do no harm, complications happen.
"If we're just a little more thoughtful about slowing down the machine, optimizing better teams and developing infrastructure to protect patients, we can avoid a lot of these things," explains Dr. Vitale. "It's a miserable thing being a surgeon trying to do good, and being the executor of patient harm."
So, Dr. Vitale called on national experts to collaboratively develop specific goals and deliverables on decreasing surgical site infections following spine surgery.
The initial meeting of 24 participants proved fruitful, eventually leading to the publication of best practices to avoid SSI in spine deformity. Driven by an energy to improve other areas of spine safety, Dr. Vitale held the meeting again in 2014 with a focus on optimizing responses after intraoperative neurological monitoring changes. The resulting paper from this meeting turned into a checklist to which most spine deformity surgeons frequently refer.
"People were clamoring to be part of the work, and we had an obligation to get the meeting to scale," remembers Dr. Vitale.
So, the Safety in Spine Surgery Summit was born in 2016, drawing a standing-room only crowd from across the United States and many other countries. On Feb. 10, 2017, Dr. Vitale chaired the second annual summit in New York City, attended by 200 people. Unfavorable weather did not deter attendance from around the nation; Dr. Vitale observed people viewed the meeting as a "fundamental mission…a sacred responsibility."
"We could fill a room with at least 500 people with this kind of content," he says. "The world is changing so quickly, people are hungry to adopt the latest techniques and methods to optimizing safety."
Lawrence Lenke, MD, surgeon-in-chief of the Spine Hospital at NewYork Presbyterian/Allen, served as a co-chair of the summit.
"I think the culture of safety and value in healthcare is very prominent in all areas, but I think spine patients and spine surgery are certainly seen as something risky and a bit controversial regarding outcomes and also very costly," he says.
Dr. Lenke reiterates that all surgeons have complications despite best efforts, and it is the surgeon's responsibility to learn how to avoid them when possible.
"There are some things that can be avoided and shame on us if we're not doing what is necessary to avoid them," Dr. Lenke says.
Summit sessions emphasized key spine safety issues such as:
• Neurological injury
• Minimally invasive spine surgery
• Implants and radiation
The afternoon highlighted spine company CEOs in a public panel: "We have these industry leaders in the field take their guard down and talk about the challenges we are all facing together, and some of the conflicts they have in regards the balance between innovation, growth and patient safety," notes Dr. Vitale. "We are all in this together."
The system-based topics, such as 'Slowing the Machine for Patient Safety,' intrigued Dr. Lenke's interest the most. He foresees a significant industry change, in which strict criteria determines surgical candidates.
"Right now, surgical decision-making is highly variable and reminiscent of the Wild West; it is still a very individualized process between surgeons and patients," explains Dr. Lenke, who attributes this to lack of standardization in the spine field.
Unlike other medical fields, spine surgery doesn't always abide by standardized diagnoses and treatments, which Dr. Lenke says is partly due to challenging diagnostic processes and highly technical procedures. "We're getting better over time; at least every orthopedic spinal surgeon must perform a fellowship to get credentialed in hospitals now," he notes.
Dr. Vitale says a shift must occur in surgeon thinking to realize the profession requires not only technical skills, but teambuilding, culture work, and safety checklists.
"I think we need to really think deeply and thoughtfully for the right dose and mechanism for innovation. It's not only about the technology or technique, it's also about the soft skills — how we think about our job," he concludes.
With interest spiking, Dr. Vitale is already planning the Third Annual Spine Safety Summit.
For more information, medical professionals can access all meeting lectures, as well as an array of checklists, pathways and guidelines on the meeting website.