The implementation and efficacy of the northwestern high risk spine protocol

Carine Zeeni, Louanne M. Carabini, Robert W. Gould, John F. Bebawy, Laura B. Hemmer, Natalie C. Moreland, Tyler R. Koski, Antoun Koht, Michael F. Schafer, Stephen L. Ondra, Dhanesh K. Gupta

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations


Objective The aims of this study were to determine the efficacy and feasibility of implementation of the intraoperative component of a high risk spine (HRS) protocol for improving perioperative patient safety in complex spine fusion surgery.

Methods In this paired availability study, the total number of red blood cell units transfused was used as a surrogate marker for our management protocol efficacy, and the number of protocol violations was used as a surrogate marker for protocol compliance.

Results The 548 patients (284 traditional vs. 264 HRS protocol) were comparable in all demographics, coexisting diseases, preoperative medications, type of surgery, and number of posterior levels instrumented. However, the surgical duration was 70 minutes shorter in the new group (range, 32-108 minutes shorter; P < 0.0001) and the new protocol patients received a median of 1.1 units less of total red blood cell units (range, 0-2.4 units less; P = 0.006). There were only 7 (2.6%) protocol violations in the new protocol group.

Conclusions The intraoperative component of the HRS protocol, based on two Do-Confirm checklists that focused on 1) organized communication between intraoperative team members and 2) active maintenance of oxygen delivery and hemostasis appears to maintain a safe intraoperative environment and was readily implemented during a 3-year period.

Original languageEnglish (US)
Pages (from-to)E815-E823
JournalWorld neurosurgery
Issue number6
StatePublished - Dec 1 2014

Bibliographical note

Publisher Copyright:
© 2014 Elsevier Inc.


  • Checklist
  • Critical pathways
  • Hemostasis
  • Patient care team
  • Spinal fusion


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