Adverse events (AEs) are still a major problem in spinal surgery, despite advances in surgical techniques, innovative technologies available and the introduction of checklist and predictive score systems aimed at reducing surgical complications. We previously analysed the results of the introduction of the WHO Safety Surgical Checklist (SSC) in our Institution, comparing the incidence of complications between two periods: from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist effectiveness. The sample size was 917 patients with an average of 30 months of follow-up. Complications were observed in 107 patients (11.6%) among 917 spinal surgery procedures performed, with 159 (17.3%) complications in total. The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. We observed a reduction of the overall incidence of complications following the introduction of the WHO Surgical Checklist: in 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%) (p<0.0005). Thus, the SSC appeared to be an effective tool to reduce complications in spinal surgery and we proposed to extend the use of checklist system also to the pre-operative and post-operative phases in order to further reduce the incidence of complications. We also believe that a correct capture and classification of complications is fundamental to generate a clinical decision support system aimed at improving patients’ safety in spinal surgery. In the period between January 2017 and January 2018 we prospectively recorded the adverse events and complications of patients undergoing spinal surgery in our department, without using any collection system. Then we retrospectively recorded the intraoperative and postoperative adverse events of surgically treated patients during the same one-year period, using the SAVES v2 system introduced by Rampersaud and collaborators (Rampersaud YR et al. J Neurosurg Spine 2016 Aug; 25 (2): 256-63) to classify them. In the one-year period from January 2017 to January 2018 a total of 336 patients underwent spinal surgery: 223 for degenerative conditions and 113 for spinal tumors. Comorbidities were collected (Charlson Comorbidity Index [CCI]). Overall, a higher number of adverse events (AEs) was recorded using SAVES compared to the prospective recording without the use of any capture system and the increased number was statistically significant for early postoperative AEs (138/336 vs 44/336, p<0.001). 210 adverse events were retrospectively recorded using the SAVES system (30 intraoperative adverse events, 138 early postoperative and 42 late postoperative adverse events). 99 patients (29.5%) on the cohort had at least one complication. Furthermore, the correlation between some risk factors and the onset of complications or the prolonged length of stay was statistically analyzed. The risk factors taken into account were: age, presence of comorbidities (CCI), ASA score, previous surgery at the same level, type of intervention, location of the disease, duration of the surgery. In particular, the duration of the surgery (more than 3 hours) and the presence of previous surgeries resulted to be risk factors for complications in multivariate analyses

Intraoperative cell salvage involves the collection of blood directly from the operative field. The purpose of this study was to determine if its use reduces the need for postoperative allogenic blood transfusion, assess any adverse events and its effect on duration of postoperative stay in primary hip arthroplasty. We prospectively examined the effect of intraoperative cell salvage on the need for postoperative allogenic blood transfusion. Between February 2009 and August 2010, a total of 77 patients who underwent primary total hip arthroplasty were included in the study, under the care of the senior author (KB). All patients had a diagnosis of osteoarthritis. Intraoperative cell salvage was used in 38 patients and not used in 39 patients. We prospectively collected data on patient demographics, ASA grade, preoperative and postoperative haematological features, number of units of packed red cells transfused and the volume of intraoperative reinfused cell salvaged blood was. Total inpatient stay and any postoperative adverse events were recorded. No patients in the cell salvage group required postoperative allogenic blood transfusion compared to three patients (7.7%) in the conventional group. Postoperative decrease in haemoglobin was less in the cell salvage group (2.57 vs. 3.3 g/dL). The mean length of postoperative inpatient stay was shorter in the cell salvage group (5.1 vs. 6.41 days). Three patients in the cell salvage group had adverse events (1 UTI, 1 hyponatraemia, 1 colonic pseudo-obstruction). Three patients in the conventional group experienced adverse events (2 superficial wound infections, 1 DVT). An average of 361mls of cell salvaged blood was reinfused (110–900mls). We have found that the use of intraoperative cell salvage in patients undergoing primary total hip arthroplasty reduces the need for post operative allogenic blood transfusion with no increase in adverse events when compared to conventional measures of blood preserving techniques