Protocol Practice in Perioperative Management of High-Risk Patients Undergoing Complex Spine Surgery

The treatment of complex spinal pathology is an often technically challenging endeavor that places a high physiological stress on the patient. While outcomes from successful deformity correction operations across a wide range of ages have demonstrated a significant improvement in quality of life, the patient must be medically fit to undergo such a procedure. The Northwestern high-risk spine protocol has been developed in order to thoroughly evaluate and treat patients in the pre-, intra-, and postoperative periods to optimize outcomes. The use of evidence based, protocol driven management strategies has been shown to improve outcomes in many aspects of medicine. The institution of such a high-risk protocol in complex spinal surgery enables the patient care team to fully assess the risk profile for a given patient and helps guide management, particularly in the setting of physiologically demanding procedures with high complication rates, such as adult deformity correction.