Nergis Khan ‘19 Princeton University Perioperative Surgical Home Impact on Blood Management for Spinal Fusion Nergis Khan ‘19 Princeton University

Adolescent Idiopathic Scoliosis

Correction = Posterior Spinal Fusion

The Perioperative Surgical Home } Multi-disciplinary team Standardized best practices Coordinated care Triple Aim

Decreased length of stay Lower opioid use Improved blood management ? Previous Results Decreased length of stay Lower opioid use Improved blood management ?

Methods PSF Patient EMR (400+ metrics) Pre-PSH (n = 44) Post-PSH RedCAP database June 2013 - Feb 2015 March 2015 - July 2017

Results 0.2 times as likely! Outcome Pre-PSH Post-PSH Intra-op transfusion 23% 6% Post-op transfusion 20% Any transfusion 39% 11% 0.2 times as likely!

Results Hematocrit Pre-PSH mean Post-PSH p-value Initial 39.3 0.93 Final 28.3 28.8 0.96 Calculated Blood Loss 1701 mL 1397 mL 0.007 Crystalloid 2313 mL 1555 mL <0.001

Fewer transfusions Adequate resuscitation = BETTER CARE Conclusion Fewer transfusions Adequate resuscitation = BETTER CARE

Additional data (MAP, etc) Patient satisfaction measure Limitations Retrospective study Additional data (MAP, etc) Patient satisfaction measure

Investigate other outcomes Expand PSH Identify at-risk patients Next Steps Investigate other outcomes Expand PSH Identify at-risk patients

Acknowledgements Thank you! Sophie Pestieau, M.D. Karen Thomson, M.D. Jessica Cronin, M.D., M.B.A. Martin Eichelberger, M.D. Anesthesiology Dept. PICS Interns CNMC Princeton Thank you!