title: Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol.
abstract: METHODS
  Review article of current literature on the preoperative evaluation and postoperative management of patients undergoing high-risk spine operations and a presentation of a multidisciplinary protocol for patients undergoing high-risk spine operation.
  
  
  OBJECTIVE
  To provide evidence-based outline of modifiable risk factors and give an example of a multidisciplinary protocol with the goal of improving outcomes.
  
  
  BACKGROUND
  Protocol-based care has been shown to improve outcomes in many areas of medicine. A protocol to evaluate patients undergoing high-risk procedures may ultimately improve patient outcomes.
  
  
  METHODS
  The English language literature to date was reviewed on modifiable risk factors for spine surgery. A multidisciplinary team including hospitalists, critical care physicians, anesthesiologists, and spine surgeons from neurosurgery and orthopedics established an institutional protocol to provide comprehensive care in the pre-, peri-, and postoperative periods for patients undergoing high-risk spine operations.
  
  
  RESULTS
  An example of a comprehensive pre-, peri-, and postoperative high-risk spine protocol is provided, with focus on the preoperative assessment of patients undergoing high-risk spine operations and modifiable risk factors.
  
  
  CONCLUSIONS
  Standardizing preoperative risk assessment may lead to better outcomes after major spine operations. A high-risk spine protocol may help patients by having dedicated physicians in multiple specialties focusing on all aspects of a patients care in the pre-, intra-, and postoperative phases.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. rhalpin004@md.northwestern.edu
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Halpin
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sugrue
authors.forename: Robert W
authors.initials: RW
authors.lastname: Gould
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kallas
authors.forename: Michael F
authors.initials: MF
authors.lastname: Schafer
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Ondra
authors.forename: Tyler R
authors.initials: TR
authors.lastname: Koski
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D013121:Spinal Curvatures / Q000601:surgery*; D013131:Spine / Q000601:surgery*