title: Evaluation of high-risk patients undergoing spinal surgery: a matched case series.
abstract: BACKGROUND
  Neuromuscular (NM) spinal deformities necessitating surgical intervention present a difficult challenge to the medical community. Underlying comorbidities lead to extended hospital stays, significant complications, and social challenges in the extensive perioperative period. In response to this problem, a therapeutic algorithm, the Care Pathway for Spinal Surgery (CAPSS) has been developed at our institution to address this complex medical issue.
  
  
  METHODS
  In 1999, a multidisciplinary team developed a treatment protocol, CAPSS, that emphasized perioperative work up and operative scheduling under the direction of a dedicated care coordinator. A case series analysis was conducted to compare the surgical outcomes from before and after CAPSS implementation. Statistical analyses were performed on a carefully paired subset of NM patients (N=9). Outcome measures were hospital length of stay (LOS), pediatric intensive care unit LOS, number of days intubated, surgical estimated blood loss, postoperative curve magnitude, percent curve correction, and perioperative complications.
  
  
  RESULTS
  Statistical analyses indicated that the use of CAPSS provided significant reduction in overall LOS, pediatric intensive care unit LOS, and perioperative complication rate within this patient group.
  
  
  CONCLUSIONS
  CAPSS is an effective method to improve perisurgical care within the NM patients with spinal deformity necessitating operative stabilization.
  
  
  METHODS
  III-Retrospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, The Musculoskeletal Research Center, Aurora, CO, USA. Miller.Nancy@tchden.org
authors.forename: Nancy Hadley
authors.initials: NH
authors.lastname: Miller
authors.forename: Elise
authors.initials: E
authors.lastname: Benefield
authors.forename: Laurel
authors.initials: L
authors.lastname: Hasting
authors.forename: Patrick
authors.initials: P
authors.lastname: Carry
authors.forename: Zhoaxing
authors.initials: Z
authors.lastname: Pan
authors.forename: Mark A
authors.initials: MA
authors.lastname: Erickson
mesh_terms: D000465:Algorithms; D016022:Case-Control Studies; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D009468:Neuromuscular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D010348:Patient Care Team / Q000458:organization & administration*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014481:United States