Disaster Scenarios in Spine Surgery: A Survey Analysis.

STUDY DESIGN: Survey analysis among spine surgeons. OBJECTIVE: To identify current consensus and discrepancies in managing adverse intraoperative events among spine surgeons. SUMMARY OF BACKGROUND DATA: Major intraoperative events are not commonly the subject of formal medical training, in part due to the relative paucity of their occurrence and in part due to an insufficient evidence base. Given the clinical impact of appropriate complication management, it is important to identify where surgeons may be able to improve decision making when choosing interventions. METHODS: A survey was created including five hypothetical unpredicted scenarios affecting different organ systems to assess the respondents' preferred reactions. The five clinical vignettes that were selected by the researchers involved: 1) loss of spinal signals in neuro-monitoring, 2) prone position cardiac arrest, 3) prone position hypoxia during thoracic corpectomy and instrumentation, 4) supine cervical vertebral artery injury, and 5) sudden onset hypotension in major prone position reconstructive spine surgery. Twenty-eight surveys (Spine Fellows n = 11; Spine surgeon Faculty n = 17) were completed and returned to the investigators. Results were sorted and ranked according to the frequency each action was identified as a top five choice. RESULTS: Following formal statistical evaluation loss of signals in neuro-monitoring had the statistically significantly most uniform response while the scenario involving cardiac compromise had the most heterogeneous. Many "best" responses had near or complete consensus while some "distractor" possibilities that could harm a patient were also selected by the respondents. CONCLUSION: The heterogeneity of responses in the face of "disaster scenario" intraoperative events shows there is room for more thorough and directed education of spine surgeons during training. As surgical teaching moves toward increased use of patient simulation and situational learning, these vignettes hopefully serve to provide direction for training future spine surgeons on how best to approach difficult situations. LEVEL OF EVIDENCE: 4.