Impact of surgeon rhBMP-2 cost awareness on complication rates and health system costs for spinal arthrodesis

OBJECTIVE Recombinant human bone morphogenetic protein–2 (rhBMP-2) is used in spinal arthrodesis procedures to enhance bony fusion. Research has suggested that it is the most cost-effective fusion enhancer, but there are significant upfront costs for the healthcare system. The primary objective of this study was to determine whether intraoperative dosing and corresponding costs changed with surgeon cost awareness. The secondary objective was to describe surgical complications before and after surgeon awareness of rhBMP-2 cost. METHODS A retrospective medical record review was conducted to identify patients who underwent spinal arthrodesis procedures performed by a single surgeon, supplemented with rhBMP-2, from June 2016 to June 2018. Collected data included rhBMP-2 dosage, rhBMP-2 list price, and surgical complications. Expected Medicare reimbursement was calculated. Data were analyzed before and after surgeon awareness of rhBMP-2 cost. RESULTS Forty-eight procedures were performed using rhBMP-2, 16 before and 32 after surgeon cost awareness. Prior to cost awareness, the most frequent rhBMP-2 dosage level was x-small (38.9%, n = 7), followed by large (27.8%, n = 5) and small (22.2%, n = 4). After cost awareness, the most frequent rhBMP-2 dosage was xx-small (56.8%, n = 21), followed by x-small (21.6%, n = 8) and large (13.5%, n = 5). The rhBMP-2 average cost per surgery was $4116.56 prior to surgeon cost awareness versus $2268.38 after. Two complications were observed in the pre—cost awareness surgical group; 2 complications were observed in the post—cost awareness surgical group. CONCLUSIONS Surgeon awareness of rhBMP-2 cost resulted in use of smaller rhBMP-2 doses, decreased rhBMP-2 cost per surgery, and decreased overall hospital admission charges, without a detectable increase in surgical complications.

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1787. The Effects of a Systemwide Diagnostic Stewardship Change on West Nile Virus Disease Ordering Practices

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1650 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S658-S658

Author(s):

Andrew H Karaba ◽

Paul W Blair ◽

Kevin M Martin ◽

Mustapha O Saheed ◽

Karen C Carroll ◽

...

Keyword(s):

West Nile Virus ◽

Virus Disease ◽

Case Fatality ◽

Cost Savings ◽

Primary Objective ◽

Neurological Deficits ◽

West Nile ◽

Hospital System ◽

Elisa Testing ◽

Before And After

Abstract Background Neuroinvasive West Nile Virus (WNV) often leads to prolonged neurological deficits and carries a high case fatality rate. The CSF IgM (MAC-ELISA) is preferred over the CSF nucleic acid-based test (NAAT) by the CDC due to its higher sensitivity. However, our hospital system was observed to have an over-utilization of NAAT testing compared with MAC-ELISA testing. The primary objective was to compare the number of MAC-ELISA and NAAT WNV tests ordered before and after a diagnostic stewardship intervention. The secondary objectives were to determine whether this change to lead to any cost savings and increased detection of probable cases of WNV-ND. Methods In an effort to increase the use of the MAC-ELISA and to decrease unnecessary NAAT testing, the NAAT test was removed in April 2018 from the test menu in the electronic health record of a health system comprising five hospitals in the Maryland and Washington, D.C. area. NAAT testing remained possible via a paper order form. This study was a retrospective review of WNV testing done on CSF samples from July 2016 through December 2018. The seasonal and yearly number of total tests, positive tests, and total costs were determined from the period of July, 2017 to April, 2018 and were compared with May, 2018 to January, 2019. A paired t-test was performed to evaluate for differences in total testing, total positives, and total costs during non-winter months before and after the intervention. Results A total of 12.59 MAC-ELISA tests/month (95% CI: 10.29, 14.89) increased to 41 tests/month (95% CI: 34.35, 47.65) which was significantly different (P < 0.001). In contrast, there were 46.23 NAAT tests/month (95% CI: 39.55, 52.91) which decreased to 0 NAAT tests/month after the intervention (P < 0.001). This resulted in an average decrease in WNV test spending from $7200 per month to $471 per month (P < 0.001). Preceding the intervention in test ordering, 0.23% of WNV CSF tests were positive (NAAT+MAC-ELISA) while 2.44% WNV CSF tests were positive after the intervention (P = 0.03). Conclusion Elimination of electronic WNV NAAT ordering is an effective way of decreasing inappropriate WNV NAAT testing, decreasing associated costs, and may lead to improved diagnosis of WNV-ND. Disclosures All authors: No reported disclosures.

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Management of chronic periodontitis: an interdisciplinary approach

International Journal of Dental Research ◽

10.14419/ijdr.v4i2.6773 ◽

2016 ◽

Vol 4 (2) ◽

pp. 65

Author(s):

Sneha Dani ◽

Savitha A.N ◽

Kenneth Tan ◽

Anand Naik ◽

Charan Chhatrala ◽

...

Keyword(s):

Public Interest ◽

Orthodontic Treatment ◽

Interdisciplinary Approach ◽

Primary Objective ◽

Periodontal Therapy ◽

The Other ◽

Periodontal Health ◽

Orthodontic Therapy ◽

Single Tooth ◽

Before And After

Objective: In recent years, advances in technique as well as a growing public interest in developing and maintaining a healthy and attractive smile, has resulted in a greater understanding of the interrelationships between periodontics and orthodontics. The primary objective of periodontal therapy is to restore and maintain the health and integrity of the attachment apparatus of teeth. In adults, the loss of teeth or periodontal support can result in pathological teeth migration involving either a single tooth or a group of teeth. This may result in the development of a diastema, incisal proclination, rotation with collapse of the posterior occlusion.Materials and methods: This case report is of a 32 year old female patient who reported with swollen gums, generalized spacing between the teeth and extruded upper anterior tooth. Periodontal therapy followed by fixed orthodontic therapy was planned.Results: At the end of 2 years a stable healthy periodontium was established that was both functional and esthetic.Conclusion: Adjunctive orthodontic therapy is often necessary for successful restoration of periodontal health. On the other hand, successful orthodontic treatment will depend on the periodontal preparation before and after treatment and the maintenance of periodontal health throughout all phases of mechano-therapy.

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Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?

10.21203/rs.3.rs-20868/v1 ◽

2020 ◽

Author(s):

Kiper Aslan ◽

Adnan Orhan ◽

Engin Turkgeldi ◽

Ebru Suer ◽

Nergis Duzok ◽

...

Keyword(s):

Posterior Wall ◽

Anterior Wall ◽

Uterine Wall ◽

Laparoscopic Myomectomy ◽

Complication Rates ◽

Analgesic Requirement ◽

Hospitalization Period ◽

Before And After ◽

Wall Groups ◽

Type 3

Abstract Objective To determine whether hemorrhage and complication rates vary according location of the dominant fibroid following laparoscopic myomectomy. Background Laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury and conversion to laparotomy may be seen in laparoscopic myomectomy. We don’t know whether fibroid location effect these complications. Materials & Methods Women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4 or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e. anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery, and complication rates were compared across categories. Results 219 women with mean age of 35.7 +/-6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. Other 10 women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 ± 2.6, 6.6 ± 2.3, and 6.7 ± 2.3 cm in the fundal, anterior and posterior groups, respectively (p=0.9). The median (25 th – 75 th percentile) changes in hemoglobin levels were 1.5 (0.8 – 2.2), 1.3 (0.6 – 2.1), and 1.3 (0.9 – 2) g/dl in fundal, anterior and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion Incidence of hemorrhage or complication does not seem to vary depending on fibroid location. However, the sample size was limited, the observed values suggest that fibroid location does not affect hemorrhage and complication rates.

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Effect of Using a Safety Checklist on Patient Complications after Surgery

Anesthesiology ◽

10.1097/aln.0000000000000232 ◽

2014 ◽

Vol 120 (6) ◽

pp. 1380-1389 ◽

Cited By ~ 63

Author(s):

Brigid M. Gillespie ◽

Wendy Chaboyer ◽

Lukman Thalib ◽

Melinda John ◽

Nicole Fairweather ◽

...

Keyword(s):

Absolute Risk ◽

Absolute Risk Reduction ◽

Cochrane Library ◽

Number Needed To Treat ◽

Complication Rates ◽

Random Effects Models ◽

Fixed And Random Effects ◽

Before And After ◽

Meta Analyses ◽

The Cochrane Library

Abstract Background: Previous before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients. Methods: A systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed. Results: Of the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P < 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192). Conclusion: Notwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

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Insights into complication rates, reoperation rates, and healthcare utilization associated with use of recombinant human bone morphogenetic protein–2 in patients with spine infections

Neurosurgical FOCUS ◽

10.3171/2018.10.focus18448 ◽

2019 ◽

Vol 46 (1) ◽

pp. E8 ◽

Cited By ~ 2

Author(s):

Mayur Sharma ◽

Nicholas Dietz ◽

Ahmad Alhourani ◽

Beatrice Ugiliweneza ◽

Dengzhi Wang ◽

...

Keyword(s):

Healthcare Utilization ◽

Bone Morphogenetic Protein 2 ◽

Complication Rates ◽

Index Hospitalization ◽

Outpatient Services ◽

Morphogenetic Protein ◽

Human Bone Morphogenetic Protein ◽

Lower Complication ◽

Reoperation Rates ◽

Recombinant Human Bone

OBJECTIVEUse of recombinant human bone morphogenetic protein–2 (rhBMP-2) in patients with spine infections is controversial. The purpose of this study was to identify long-term complications, reoperations, and healthcare utilization associated with rhBMP-2 use in patients with spine infections.METHODSThis retrospective study extracted data using ICD-9/10 and CPT codes from MarketScan (2000–2016). Patients were dichotomized into 2 groups (rhBMP-2, no rhBMP-2) based on whether rhBMP-2 was used during fusion surgery for spinal infections. Outcomes of interest were reoperation rates (index level, other levels), readmission rates, discharge disposition, length of stay, complications, and healthcare resource utilization at the index hospitalization and 1, 3, 6, 12, and 24 months following discharge. Outcomes were compared using nonparametric 2-group tests and generalized linear regression models.RESULTSThe database search identified 2762 patients with > 24 months’ follow-up; rhBMP-2 was used in 8.4% of their cases. The patients’ median age was 53 years, 52.43% were female, and 15.11% had an Elixhauser Comorbidity Index ≥ 3. Patients in the rhBMP-2 group had higher comorbidity indices, incurred higher costs at index hospitalization, were discharged home in most cases, and had lower complication rates than those in the no–rhBMP-2 group. There was no statistically significant between-groups difference in complication rates 1 month following discharge or in reoperation rates at 3, 6, 12, and 24 months following the procedure. Patients in the no–rhBMP-2 group incurred higher utilization of outpatient services and medication refill costs at 1, 3, 6, 12, and 24 months following surgery.CONCLUSIONSIn patients undergoing surgery for spine infection, rhBMP-2 use was associated with lower complication rates and higher median payments during index hospitalization compared to cases in which rhBMP-2 was not used. There was no significant between-groups difference in reoperation rates (index and other levels) at 3, 6, 12, and 24 months after the index operation. Patients treated with rhBMP-2 incurred lower utilization of outpatient services and overall payments. These results indicate that rhBMP-2 can be used safely in patients with spine infections with cost-effective utilization of healthcare resources and without an increase in complications or reoperation rates.

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Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191330 ◽

2020 ◽

Vol 33 (3) ◽

pp. 297-306

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Rushikesh S. Joshi ◽

Christopher P. Ames

Keyword(s):

Risk Factor ◽

Complication Rate ◽

Surgical Complications ◽

Deformity Correction ◽

Neurological Deficits ◽

Wedge Osteotomy ◽

Medical Complication ◽

Complication Rates ◽

Cervical Deformity ◽

Significant Difference

OBJECTIVEThe correction of severe cervicothoracic sagittal deformities can be very challenging and can be associated with significant morbidity. Often, soft-tissue releases and osteotomies are warranted to achieve the desired correction. There is a paucity of studies that examine the difference in morbidity and complication profiles for Smith-Petersen osteotomy (SPO) versus 3-column osteotomy (3CO) for cervical deformity correction.METHODSA retrospective comparison of complication profiles between posterior-based SPO (Ames grade 2 SPO) and 3CO (Ames grade 5 opening wedge osteotomy and Ames grade 6 closing wedge osteotomy) was performed by examining a single-surgeon experience from 2011 to 2018. Patients of interest were individuals who had a cervical sagittal vertical axis (cSVA) > 4 cm and/or cervical kyphosis > 20° and who underwent corrective surgery for cervical deformity. Multivariate analysis was utilized.RESULTSA total of 95 patients were included: 49 who underwent 3CO and 46 who underwent SPO. Twelve of the SPO patients underwent an anterior release procedure. The patients’ mean age was 63.2 years, and 60.0% of the patients were female. All preoperative radiographic parameters showed significant correction postoperatively: cSVA (6.2 cm vs 4.5 cm [preoperative vs postoperative values], p < 0.001), cervical lordosis (6.8° [kyphosis] vs −7.5°, p < 0.001), and T1 slope (40.9° and 35.2°, p = 0.026). The overall complication rate was 37.9%, and postoperative neurological deficits were seen in 16.8% of patients. The surgical and medical complication rates were 17.9% and 23.2%, respectively. Overall, complication rates were higher in patients who underwent 3CO compared to those who underwent SPO, but this was not statistically significant (total complication rate 42.9% vs 32.6%, p = 0.304; surgical complication rate 18.4% vs 10.9%, p = 0.303; and new neurological deficit rate 20.4% vs 13.0%, p = 0.338). Medical complication rates were similar between the two groups (22.4% [3CO] vs 23.9% [SPO], p = 0.866). Independent risk factors for surgical complications included male sex (OR 10.88, p = 0.014), cSVA > 8 cm (OR 10.36, p = 0.037), and kyphosis > 20° (OR 9.48, p = 0.005). Combined anterior-posterior surgery was independently associated with higher odds of medical complications (OR 10.30, p = 0.011), and preoperative kyphosis > 20° was an independent risk factor for neurological deficits (OR 2.08, p = 0.011).CONCLUSIONSThere was no significant difference in complication rates between 3CO and SPO for cervicothoracic deformity correction, but absolute surgical and neurological complication rates for 3CO were higher. A preoperative cSVA > 8 cm was a risk factor for surgical complications, and kyphosis > 20° was a risk factor for both surgical and neurological complications. Additional studies are warranted on this topic.

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P109 Experience of tunnelled vs. bolt EVDs on the intensive care unit

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.164 ◽

2019 ◽

Vol 90 (3) ◽

pp. e50.4-e51

Author(s):

H Asif ◽

CL Craven ◽

U Reddy ◽

LD Watkins ◽

AK Toma

Keyword(s):

Intensive Care Unit ◽

External Ventricular Drain ◽

Complication Rates ◽

Single Centre ◽

Acute Hydrocephalus ◽

Clinical Notes ◽

Before And After ◽

Csf Diversion ◽

Neurosurgical Operation ◽

Mean Time

ObjectivesThe placement of an external ventricular drain (EVD) is a common neurosurgical operation that carries great benefit in acute hydrocephalus but is not without risk. In our centre, bolt EVDs (B-EVD) are being placed in favour of tunnelled EVDs (T-EVD). The former has allowed for urgent CSF diversion in ITU. We compared EVD survival and complication rates between the two types of EVDs.DesignSingle centre prospective case-cohort.SubjectsTwenty-five patients with B-EVDs and thirty-four patients with T-EVDs.MethodsClinical notes and radiographic reports were collected before and after the placement of EVDs for patients in ITU between January 2017 and June 2018.ResultsFourteen of the 25 B-EVDs were placed on ITU, of which 2 were under stealth guidance. All 34 T-EVDs were placed in theatre. Mean time to CSF access after decision for diversion was 134 min in the B-EVD group and 227 min in the T-EVD group (p<0.05). Mean survival was 35 days for B-EVDs and 29 days for T-EVDs (p<0.05). Eight T-EVDs went onto be replaced as B-EVDs due to retraction or infection. Complications including infection, detachment or retraction were higher in the T-EVD group at 32% compared to 20% in the B-EVD group.ConclusionsBolt EVDs have a lower frequency of complications and higher survival compared to tunnelled EVDs. Since B-EVDs require fewer resources they can be placed faster and on ITU.

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Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1676793 ◽

2018 ◽

Vol 80 (06) ◽

pp. 586-592

Author(s):

Uma Patnaik ◽

Smriti Panda ◽

Alok Thakar

Keyword(s):

Skull Base ◽

Surgical Complications ◽

Skull Base Surgery ◽

Major Complication ◽

Anterior Skull Base ◽

Complication Rates ◽

Permanent Disability ◽

Lateral Skull Base ◽

Significant Difference ◽

Surgical Complexity

Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective. Design This study was designed with consecutive cohort of skull base surgical cases. Setting Tertiary referral academic center. Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015. Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery. Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity. Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.

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P90 TRACTION ON THE SEPTUM DURING TRANSORAL SEPTOTOMY FOR ZENKER DIVERTICULUM IMPROVES THE FINAL OUTCOME

Diseases of the Esophagus ◽

10.1093/dote/doz092.90 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

L Provenzano ◽

R Salvador ◽

C Cutrone ◽

L Moletta ◽

E Pierobon ◽

...

Keyword(s):

Symptom Score ◽

Final Outcome ◽

Barium Swallow ◽

Complication Rates ◽

Duration Of Symptoms ◽

Zenker Diverticulum ◽

Before And After ◽

Study Population ◽

Classic Technique ◽

Additional Procedure

Abstract Background Transoral Diverticulostomy/Septotomy has become a popular treatment for patients with Zenker Diverticulum (ZD) because of the low complication rates, reduced procedure time, and shorter hospital stay. However, the outcome of this procedure is not, so far, as positive as the open techniques. In order to improve the results of transoral septotomy (TS), a modification of the technique by tractioning the septum with stiches, has been introduced. In this study we aimed to compare the final outcome of a Modify Transoral Septotomy (MTS) with those of the Traditional Transoral Septotomy (TTS) in patients with ZD. Methods Seventy-seven consecutive patients with ZD underwent Transoral Septotomy between 2010-2019. Patients who had already been treated with surgical or endoscopic procedures were excluded. TTS was performed with the classic technique. Since 2015, we adopted a MTS, by positioning 2 sutures at the lateral edges of the septum, for traction. Symptoms were collected and scored using a detailed questionnaire; barium-swallow (to assess the size of the pouch), endoscopy and manometry were performed before and after surgical treatment. Failures were defined when a patient needed an additional procedure for recurrent symptoms. Results Of the 52 patients representing the study population (M:F=49:28), 25 had TTS and 52 had MTS. The patients’ demographic and clinical parameters (sex, age, symptom-score, duration of symptoms, diverticulum size) were similar in both groups. Only two intraoperative mucosal lesions were detected and mortality was nil. The median time of the procedure was 25 min (IQR:22-35) in the TTS and 30 min (IQR:25-36) in the MTS (p<0.07). The median follow-up was 85 months in the TTS and 24 months in the MTS. All the patients in both groups had a reduction in the symptom score after the procedure but the failure rate was 32% (8/25) in the TTS and 1.9% (1/52) in the MTS (p<0.01). At the univariate and multivariate analyses, the surgical procedure was the only factor predictive of a positive final result. Conclusions Transoral Septotomy improves the final outcome of this treatment in patients with ZD.

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The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

Journal of Clinical Medicine ◽

10.3390/jcm9124006 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4006

Author(s):

Thomas Lustenberger ◽

Simon Lars Meier ◽

René Danilo Verboket ◽

Philipp Störmann ◽

Maren Janko ◽

...

Keyword(s):

Complication Rate ◽

Surgical Outcomes ◽

Surgical Complications ◽

Situational Awareness ◽

Surgical Complication ◽

Surgical Site Infections ◽

Care Bundle ◽

Trauma Patients ◽

Complication Rates ◽

Time Period

Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.

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