Development of multidisciplinary, evidenced-based protocol recommendations and implementation strategies for anterior lumbar interbody fusion surgery following a literature review

The anterior lumbar interbody fusion (ALIF) procedure involves several surgical specialties, including general, vascular, and spinal surgery due to its unique approach and anatomy involved. It also carries its own set of complications that differentiate it from posterior lumbar fusion surgeries. The...

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Bibliographic Details
Published in:	Medicine (Baltimore) Vol. 102; no. 47; p. e36142
Main Authors:	Meyrat, Richard, Vivian, Elaina, Sridhar, Archana, Gulden, R Heath, Bruce, Sue, Martinez, Amber, Montgomery, Lisa, Reed, Jr, Donald N, Rappa, Peter J, Makanbhai, Hetendra, Raney, Kenneth, Belisle, Jennifer, Castellanos, Stacey, Cwikla, Judy, Elzey, Kristin, Wilck, Kristen, Nicolosi, Fallon, Sabat, Michael E, Shoup, Chris, Graham, Randall B, Katzen, Stephen, Mitchell, Bartley, Oh, Michael C, Patel, Nimesh
Format:	Journal Article
Language:	English
Published:	United States 24-11-2023
Subjects:	Humans Lumbar Vertebrae - surgery Lumbosacral Region - surgery Neurosurgical Procedures Postoperative Complications - prevention & control Postoperative Complications - surgery Review Literature as Topic Spinal Fusion - methods Treatment Outcome
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Summary:	The anterior lumbar interbody fusion (ALIF) procedure involves several surgical specialties, including general, vascular, and spinal surgery due to its unique approach and anatomy involved. It also carries its own set of complications that differentiate it from posterior lumbar fusion surgeries. The demonstrated benefits of treatment guidelines, such as Enhanced Recovery after Surgery in other surgical procedures, and the lack of current recommendations regarding the anterior approach, underscores the need to develop protocols that specifically address the complexities of ALIF. We aimed to create an evidence-based protocol for pre-, intra-, and postoperative care of ALIF patients and implementation strategies for our health system. A 12-member multidisciplinary workgroup convened to develop an evidence-based treatment protocol for ALIF using a Delphi consensus methodology and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for rating the quality of evidence and strength of protocol recommendations. The quality of evidence, strength of the recommendation and specific implementation strategies for Methodist Health System for each recommendation were described. The literature search resulted in 295 articles that were included in the development of protocol recommendations. No disagreements remained once the authors reviewed the final GRADE assessment of the quality of evidence and strength of the recommendations. Ultimately, there were 39 protocol recommendations, with 16 appropriate preoperative protocol recommendations (out of 17 proposed), 9 appropriate intraoperative recommendations, and 14 appropriate postoperative recommendations. This novel set of evidence-based recommendations is designed to optimize the patient's ALIF experience from the preoperative to the postoperative period.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0025-7974 1536-5964 1536-5964
DOI:	10.1097/MD.0000000000036142