No S.C.A.R.E. Protocol: A Streamlined Safety Protocol

Tyler James Jenkins*, Ryan D. Snowden, Joseph Smucker, Wellington K. Hsu, K. Dan Riew, Rick C. Sasso

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: Despite the proven success of anterior cervical surgery (ACS) postoperative issues can arise, with retropharyngeal hematoma (RH) being one of the most feared. A recent USA Today article highlighted the failed management and subsequent death of patients developing RH after ACS. The article calls into question the safety of performing ACS in an outpatient setting. Methods: We tested the knowledge of 20 healthcare professionals (4 surgeons, 16 ancillary providers) regarding ways to minimize the post-ACS complications. We used a multiple-choice and fill-in-the-blank test. We then developed a No S.C.A.R.E. safety protocol and after teaching the same professionals, re-administered the examination to assess improvement. Results: We identified large gaps in knowledge between spine surgeons and other providers (92.3% versus 31.2%) on preintervention testing. Postintervention testing showed significant improvement in nonsurgeon scores (31.2% to 86.1%, P <0.01). Improvement was also seen in provider confidence after completion of the education module. Conclusion: Previous studies demonstrate that the incidence of RH necessitating evacuation after ACS is extremely small (1 <1%). For rare complications, healthcare teams may benefit from educational modules and standardized protocols. After implementation of our No S.C.A.R.E. protocol, provider knowledge and confidence markedly improved. We recommend similar education modules and protocols be used at other institutions performing ACS.

Original languageEnglish (US)
Pages (from-to)21-28
Number of pages8
JournalJournal of the American Academy of Orthopaedic Surgeons
Issue number1
StatePublished - Jan 1 2020

ASJC Scopus subject areas

  • Medicine(all)


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