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

2. Adolescent Idiopathic Scoliosis

3. Correction = Posterior Spinal Fusion

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

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

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

7. 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!

8. 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

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

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

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

12. 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!