Skip to main content
NCBI home page
Medicine International logoLink to Medicine International
. 2025 Feb 24;5(3):23. doi: 10.3892/mi.2025.222

Quality improvement in neurosurgery: A systematic review

Mohamed M Madan 1, Ahmed M Alshereiqi 2, Noor M Abdulla 1, Maryam Albreiki 3, Tariq Al-Saadi 4,✉
PMCID: PMC11907216  PMID: 40093580

Abstract

Quality improvement (QI) is crucial for advancing patient care and safety in surgical practices. Despite the presence of numerous systematic reviews on various types of surgeries, no current QI systematic review for neurosurgery is available, at least to the best of our knowledge. The present study thus aimed to explore existing QI frameworks, interventions and outcome measures, which are used to enhance patient care and efficiency in neurosurgery. For this purpose, a systematic review was conducted by identifying 75 articles using key words, such as ‘Quality’, ‘Control’, ‘Improvement’, ‘Neurosurgical’ and ‘Neurosurgery’ across various databases, including PubMed, Google Scholar, Scopus, Wiley, ScienceDirect and Microsoft Academic. Each article was assessed based on inclusion and exclusion criteria, without a time limit for selection. The analysis of the 75 publications revealed an uneven distribution across neurosurgical fields: Adult neurosurgery (70.5%), spine surgery (22.5%), pediatric neurosurgery (4%) and neuro-oncology (3%). This pattern was reflected in the patient distribution (n=621,293), with 87.07% involved in spine surgery QI initiatives. Cranial-only and combined cranial and spinal studies accounted for only 0.21% of patients. QI interventions included mainly new protocols (18.67%), ERAS (17.33%), data analysis (16%), modified checklists (14.67%) and new sterilization devices (13.3%). By contrast, only a limited number of articles addressed the effectiveness of new technology, prediction models, incident reporting and staff education. On the whole, the QI studies enhanced neurosurgical care, focusing mainly on adult neurosurgery and targeting specifically spinal cases. The main interventions included new protocols, ERAS, data analysis and checklists. Further research is required to address QI initiatives in cranial surgery and evaluate the effectiveness of less commonly used methods, such as new technologies and predictive models.

Keywords: quality improvement, neurosurgery, patient safety, patient care, spine surgery, cranial surgery, ERAS, protocols

Introduction

Quality improvement (QI) is a critical aspect of advancing patient care, enhancing outcomes and ensuring the highest standards of safety and efficiency in surgical practices (1-4). Neurosurgery, with its inherent complexities and high risks, demands attention to detail and a persistent pursuit of excellence. Severe perioperative complications in neurosurgical patients can lead to considerable harm, morbidity, permanent disability, or even mortality. The recovery period following such procedures is frequently complex, requiring extended rehabilitation and the use of expensive specialized resources (2-5). The field has seen notable advancements over the years, driven by innovative surgical techniques, cutting-edge technology and a deeper understanding of neurological conditions (3). However, the complexity and risks associated with neurosurgical procedures require a robust framework for continuous QI. This involves systematically identifying areas for enhancement, implementing evidence-based interventions, and rigorously evaluating outcomes to ensure sustained improvements (5). In this context, QI initiatives aim to reduce complications, optimize patient recovery, and enhance overall surgical success rates, thereby elevating the standard of care for patients (6).

Despite the presence of numerous systematic reviews on various types of surgeries, such as otolaryngology-head and neck surgeries, cleft palate surgeries and laparoscopic surgeries (7-9), current systematic reviews for QI dedicated to neurosurgery have not been established, at least to the best of our knowledge. The present systematic review thus aimed to explore existing evidence, gaps in current practices and standardized QI measures utilized in neurosurgery.

Data and methods

For the present systematic review, articles were selected based on a set of predetermined key words, including ‘Quality’, ‘Control’, ‘Improvement’, ‘Neurosurgical’ and ‘Neurosurgery’. These key words were strategically selected to ensure a comprehensive search and capture all relevant studies within the scope of neurosurgical quality control and improvement. In order to gather the scientific publications, the key words were applied across six major internet search databases: PubMed, Google Scholar, Scopus, Wiley, ScienceDirect and Microsoft Academic. These databases were selected due to their extensive repositories and relevance to the field. Initially, a total of 391 scientific publications were retrieved from these databases. During the initial review, 31 articles were found to be duplicates and were subsequently removed, leaving a total of 360 unique papers for further screening (Fig. 1). The screening process was meticulous and involved a detailed examination of the relevance of each article to the inclusion and exclusion criteria set by the research team. In order to maintain the meticulousness of the screening process at a high level, all reviews and studies that tended to provide information on new interventions to improve the quality of services in neurosurgery were included; articles that discussed non-neurosurgical interventions and were not related to QI were excluded.

Figure 1.

Figure 1

Open in a new tab

PRISMA flow diagram illustrating the process of article inclusion and exclusion for the present systematic review.

This process narrowed the selection down to 75 publications deemed most pertinent for inclusion in the systematic review. The selected scientific articles were found to fall between 2004 and 2023. Although there was no time frame restriction, there were no further articles located prior to that time frame. This 19-year period provided a comprehensive overview of the developments and trends in neurosurgical quality control and improvement. During the screening stage, only articles written in the English language were considered, resulting in the exclusion of two non-English publications. This decision was made to maintain consistency and ensure that all reviewed articles were accessible to the research team.

Results

The 75 publications (listed in Table I) (2,4,5,10-81) revealed an uneven distribution across four main fields of neurosurgery. Adult neurosurgery encompassed the largest proportion of 70.5%, accounting for 53 articles (2,4,5,13,14,16-23,26-29,31-33,35-40,45,48,50-55,57-65,67-70,72-77). This was followed by spine surgery with 17 articles (22.5%) (10-12,24,30,41-44,46,47,56,71,78-81), pediatric neurosurgery with three articles (4%) (15,25,34) and neuro-oncology exclusive studies with the lowest proportion of 3%, representing two articles (49,66) (Table I and Fig. 2). There was also a marked disparity in the distribution of targeted patients (n=621,293) across the different fields of neurosurgery. QI studies focusing on spinal-only cases comprised the vast majority of patients at 87.07% (n=540,955) (10-12,24,30,41-44,46,47,56,71,78-81), while cranial-only studies and combined cranial and spinal studies accounted for 0.21% of the total patients collectively (n=1,309) (2,4,5,13,14,16-23,26-29,31-33,35-40,45,48,50-55,57-65,67-70,72-77). Additionally, the unspecified category accounted for 12.72% (73,29) of patients (15,25,34,49,66) (Table II).

Table I.

Summary of all relevant findings in the included quality improvement studies.

Article no. First author Year of publication Country Field of neurosurgery Targeted patients No. of patients QI intervention Research design (Refs.)
1 Ziewacz 2015 USA Spine surgery All patients undergoing neurosurgery Unspecified Education Correlational study (10)
2 Anderson 2016 USA Spine surgery Patients underwent spine surgery Data on HAI from over 1545 hospital facilities with unspecified number of patients Infection prevention and sterilization Systematic review (11)
3 Lindbäck 2017 Sweden Spine surgery Patients with degenerative lumbar spine disorder 197 Protocol and audit Randomized clinical trial (12)
4 McLaughlin 2015 USA Adult neurosurgery All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study except interventional radiology and stereotactic radiosurgery procedures 6,912 Incidence reporting Systematic review (13)
5 Robertson 2018 USA Adult neurosurgery Patients undergoing elective cranial or spinal neurosurgery 416 Patient compliance and safety Randomized clinical trial (14)
6 Pendola 2022 USA Pediatric neurosurgery Pediatric neurosurgery 129 Data analysis and review Cross-sectional study (15)
7 Ashraf 2021 Pakistan Adult neurosurgery Elective cases of both cranial and spinal neurosurgical diseases. 100 Protocol and audit Audit study (16)
8 Isaacs 2022 Canada Adult neurosurgery Adult patients (aged ≥18 years) undergoing VP shunt surgery 244 Infection prevention and sterilization Audit study (17)
9 Bekelis 2015 USA Adult neurosurgery Unspecified Unspecified Data analysis and review Prospective cohort study (18)
10 Zuckerman 2012 USA Adult neurosurgery All patients undergoing neurosurgical procedures. Unspecified Checklist Systematic review (19)
11 Ali 2021 USA Adult neurosurgery neurosurgical patients at an urban, level I trauma, academic teaching hospital. Unspecified Education Prospective cohort study (20)
12 Asher 2015 USA Adult neurosurgery Unspecified Unspecified Data analysis and review Prospective cohort study (21)
13 Kerezoudis 2021 USA Adult neurosurgery National Surgical Quality Improvement Program abstracted neurosurgical cases 317 Infection prevention and sterilization Systematic review (22)
14 Sisler 2017 USA Adult neurosurgery Patients 18 years of age or older who indicated current tobacco use (that is, in the 30 days prior to admission) were admitted to the inpatient neurosurgical service 526: 189 from the period between July 1, 2014, and December 31, 2014 taken as control and 337 from period between January 1, 2015 to December 31, 2015 taken as the intervention group Protocol and audit Randomized clinical trial (23)
15 Deyo 2009 USA Spine surgery Patients underwent spine surgery Unspecified Data analysis and review Prospective cohort studies (24)
16 Ruiz Colón 2023 USA Pediatric neurosurgery Pediatric patients Unspecified Data analysis and review Systematic review (25)
17 Yang 2015 USA Adult neurosurgery Unspecified Unspecified Data analysis and review Prospective cohort studies (26)
18 Stumpo 2021 USA Adult neurosurgery-cranial Unspecified Unspecified ERAS Systematic review (27)
19 Wang 2020 USA Adult neurosurgery Unspecified Unspecified Data analysis and review Case report (28)
20 Meyrat 2021 USA Adult neurosurgery Ambulatory and hospital cases of neurosurgery 2,646: 2,270 were ambulatory dataset and 376 were a hospital dataset Patient compliance and safety Correlational study (29)
21 Tanenbaum 2016 USA Spine surgery All adult patients aged 18 years and older included in the nation-wide inpatient sample (NIS) that underwent lumbar fusion from 1998-2011 53,9172 Patient compliance and safety Prospective cohort study (30)
22 Groman 2015 USA Adult neurosurgery Unspecified Unspecified Data analysis and review Prospective cohort studies (31)
23 Hall 2019 UK Adult neurosurgery Patients returning from the operating department to the neuro-surgical ward 100 Checklist Randomized clinical trial (32)
24 McLaughlin 2014 USA Adult neurosurgery All patients undergoing neurosurgery Unspecified Protocol and audit Systematic review (33)
25 Shi 2023 USA Pediatric neurosurgery Children undergoing spinal surgery Unspecified Data analysis and review Randomized clinical trial (34)
26 Oszvald 2012 Germany Adult neurosurgery All patients undergoing neurosurgery 12,390 Checklist Randomized clinical trial (35)
27 Sarnthein 2016 Switzerland Adult neurosurgery-cranial All patients undergoing neurosurgery 2,880 Protocol and audit Correlational study (36)
28 Zuckerman 2015 North America Adult neurosurgery All patients undergoing neurosurgery Unspecified Checklist Systematic review (37)
29 Ber 2021 USA Adult neurosurgery All patients undergoing neurosurgery 1,530 Technology Randomized clinical trial (38)
30 Liu 2022 China Adult neurosurgery Patients >65 years of age undergoing neurosurgeries Unspecified ERAS Systematic review (39)
31 Benjamin 2022 USA Adult neurosurgery Patients undergoing endoscopic endonasal resection of pituitary adenomas 171 Protocol and audit Case-control study (40)
32 Norris 2023 USA Spine surgery Patients ≥18 years of age meeting one of the following high-risk criteria: 8 + levels fused, osteoporosis with 4 + levels fused, three column osteotomy, anterior revision of the same lumbar level, or planned significant correction for severe myelopathy, scoliosis (>75˚), or kyphosis (>75˚) 263 Data analysis and review Prospective cohort study (41)
33 Debono 2021   Spine surgery Patients undergoing lumbar spinal fusion Unspecified ERAS Systematic review (42)
34 Elsarrag 2019 USA Spine surgery Pediatric patients with spinal deformities 132 ERAS Systematic review (43)
35 Dietz 2019 India Spine surgery Patients with brain tumors 500 ERAS Systematic review (44)
36 Elayat 2021 India Adult neurosurgery Adult patients scheduled for elective supratentorial intracranial tumor excision 70 ERAS Randomized clinical trial (45)
37 Koucheki 2021 Canada Spine surgery Individuals with adolescent idiopathic scoliosis 2,456 ERAS Systematic review (46)
38 Kerolus 2021 USA Spine surgery Patients undergoing an elective single-level MIS TLIF for degenerative changes at a single institution 299 ERAS Randomized clinical trial (47)
39 Wang 2022 China Adult neurosurgery Patients who underwent elective craniotomy between January 2019 and June 2020. 151 ERAS Randomized clinical trial (48)
40 Greisman 2022 USA Neuro-oncology Patients undergoing cranial tumor resection. Unspecified ERAS Systematic review (49)
41 Suresh 2021 India Adult neurosurgery Undergoing elective neurosurgical procedures, specifically 131 cases of craniotomy and 69 cases of spine surgery 200 Checklist Cross-sectional study (50)
42 Westman 2020 Finland Adult neurosurgery Patients undergoing neurosurgical procedures. Unspecified Checklist Systematic review (2)
43 Lepänluoma 2014 Finland Adult neurosurgery Neurosurgical patients 150 Checklist Cross-sectional study (51)
44 Soriano Sánchez 2019 Mexico Adult neurosurgery Neurosurgical patients Unspecified Checklist Systematic review (52)
45 Lau. 2012 USA Adult neurosurgery Neurosurgical patients Unspecified Checklist Prospective cohort study (53)
46 Enchev 2015 Bulgaria Adult neurosurgery Neurosurgical patients Unspecified Checklist Systematic review (54)
47 Silva-Freitas 2012 Spain Adult neurosurgery Neurosurgical patients 400 Checklist Pre/post-intervention study (55)
48 Schaffzin 2015 USA Spine surgery Pediatric patients undergoing cardio-thoracic, neurosurgical shunt, and spinal fusion surgeries Unspecified Infection prevention and sterilization Cross-sectional study (56)
49 Pauli 2017 Brazil Adult neurosurgery Patients with mesial temporal lobe epilepsy undergoing anterior temporal lobectomy 50 ERAS Systematic review (57)
50 Tian 2022 China Adult neurosurgery Neurosurgical patients 24,137 Infection prevention and sterilization Systematic review (58)
51 Wang 2020 China Adult neurosurgery Patients admitted to the neurosurgery intensive care unit between January 2017 and February 2018, in Capital Medical University, Beijing, China 310 Prediction model Systematic review (59)
52 Annette 2005 Sweden Adult neurosurgery Neurosurgical intensive care unit patients Unspecified Education Cross-sectional study (60)
53 Krushelnytskyy 2022 USA Adult neurosurgery Neurosurgical patients Unspecified Protocol and audit Audit study (61)
54 Kassicieh 2022 USA Adult neurosurgery-cranial Patients with inter-hospital transfer status 47,736 NA Prospective cohort study (62)
55 Witiw 2015 USA Adult neurosurgery Neurosurgical patients Unspecified Infection prevention and sterilization Randomized clinical trial (5)
56 Neal 2021 USA Adult neurosurgery Neurosurgical patients Unspecified Framework Audit study (4)
57 Rotter 2022 USA Adult neurosurgery Patients requiring external ventricular drain (EVD) or intracranial pressure (ICP) monitor placement Unspecified Protocol and audit Audit study (63)
58 Schipmann 2016 Germany Adult neurosurgery-cranial Patients undergoing cranial neurosurgery 70 cases with surgical site infections and 185 matched controls Infection prevention and sterilization Case-control studies (64)
59 Rubiano 2012 USA Adult neurosurgery-cranial Neurotrauma patients in low- and middle-income countries Unspecified Data analysis and review Systematic review (65)
60 Fischer 2015 USA Neuro-oncology Pediatric patients with brain tumors Unspecified Data analysis and review Systematic review (66)
61 Bernstein 2004 Canada Adult neurosurgery Patients undergoing novel neurosurgical procedures Unspecified Framework Systematic review (67)
62 Leming-Lee 2019 USA Adult neurosurgery Neurosurgical patients undergoing craniotomy procedures Unspecified Infection prevention and sterilization Pre/post-intervention studies (68)
63 Hover 2013 USA Adult neurosurgery Patients undergoing elective neurosurgical procedures Unspecified Infection prevention and sterilization Pre/post-intervention studies (69)
64 Mathews 2015 USA Adult neurosurgery Elective neurosurgical patients 2,328 Protocol and audit Case report (70)
65 Rupich 2018 USA Spine surgery Postoperative neuro-surgical spine patients Unspecified ERAS Case-control study (71)
66 Rozman 2020 USA Adult neurosurgery Neurosurgical patients Unspecified Protocol and audit Pre/post-intervention study (72)
67 Farrokhi 2013 USA Adult neurosurgery Patients undergoing minimally invasive spine surgery Unspecified Protocol and audit Audit study (73)
68 Xu 2013 China Adult neurosurgery Critically ill patients in a neurosurgical intensive care unit Unspecified Protocol and audit Audit study (74)
69 Chang 2021 USA Adult neurosurgery-cranial Patients requiring external ventricular drain (EVD) placement in the emergency department 38 (20 during protocol initia tion and 18 pre-protocol) Patient compliance and safety Pre/post-intervention study (75)
70 Ezeamuzie 2019 USA Adult neurosurgery Patients undergoing complex surgical procedures with increased operative time) 212 Protocol and audit Prospective case-control study (76)
71 Kantelhardt 2011 Germany Adult neurosurgery Neurosurgical patients Unspecified Incidence reporting Pre/post-intervention studies (77)
72 Ryan 2014 USA Spine surgery Pediatric patients undergoing complex spine surgery 267 Infection prevention and sterilization Pre/post-intervention study (78)
73 Kantelhardt 2016 Germany Spine surgery Patients undergoing spinal surgery 149 Checklist Pre/post-intervention study (79)
74 Licina 2021 Australia Spine surgery Patients undergoing spinal surgery Unspecified ERAS Systematic review (80)
75 Young 2020 USA Spine surgery Patients undergoing elective spine procedures 1,000 Protocol and audit Pre/post-intervention study (81)
Open in a new tab

Figure 2.

Figure 2

Open in a new tab

Bar chart depicting the number of quality improvement publications in four main fields in neurosurgery.

Table II.

Quality improvement in neurosurgeries and sub-subspecialties.

Targeted patients No. of patients Percentage (Refs.)
Spinal only 540,955 87.07 (10-12,24,30,41-44,46,47,56,71,78-81)
Unspecified 79,029 12.72 (15,25,34,49,66)
Cranial + spinal 673 0.11 (13,14,16-23,25,26,28,29,31-33,35,37-40,45,48,50-55,57-4,5,61,63,67-70,72-74,76,77)
Cranial only 636 0.1 (27,36,62,64,65,75)
Open in a new tab

Different interventions were used to improve QI and enhance care in neurosurgery. Implementing new protocols and audits was the most common intervention with 14 articles (18.67%) (12,16,23,33,36,40,61,63,70,72-74,76,81). This was followed by enhanced recovery after surgery (ERAS) with 13 articles (17.33%) (27,39,42,49,57,71,80), data analysis of databases, registries, and literature with 12 articles (16%) (15,18,21,24-26,28,31,34,41,65,66), new or modified checklists implementation with 11 articles (14.67%) (2,19,32,35,37,50-52,54,55,79), and utilizing new sterilization devices or protocols with 10 articles (13.3%) (5,11,17,22,56,58,64,68,69,78). Less frequently addressed interventions were utilizing new technology, using a prediction model, improving incident reporting, increasing patient compliance, and educating the neurosurgical staff (10,13,14,20,29,30,38,53,59,60,75,77) (Fig. 3).

Figure 3.

Figure 3

Open in a new tab

Bar chart depicting the different interventions used to provide quality improvement in neurosurgical care.

The study design varied within the 75 publications and covered the whole research design pyramid from systematic reviews, the most authentic and strongest research design, to case studies, the least authentic and weakest research design. The predominant design was systematic review studies with 24 articles (32%) (2,11,13,19,22,25,27,33,37,39,42,43,44,46,49,52,54,57-59,65-67,80), followed by randomized clinical trials with 11 articles (14.67%) (5,12,14,23,32,34,35,38,45,47,48), and prospective cohort studies with 10 articles (13.33%) (18,20,21,24,26,30,31,41,53,62). The least research designs used were prospective case-control studies with only one article (1.33%) (77), case reports with two articles (2.67%) (28,37), and correlation (10,29,36) and retrospective (40,64,71) studies with three articles (4%) each. Other types of studies, such as audit studies (4,16,17,61,63,73,74) and cross-sectional studies (15,50,51,56,60) were in between (Table III).

Table III.

Research design of the selected studies.

Types of studies No. of studies Percentage (Refs.)
Systematic review studies 24 32.00 (2,11,13,19,22,25,27,33,37,39,42,43,44,46,49,52,54,57-59,65,69,67,80)
Randomized clinical trials 11 14.67 (12,14,23,32,34,35,38,45,47,48,63)
Prospective cohort studies 10 13.33 (18,20,21,24,26,30,31,41,53,62)
Pre/post-intervention studies 9 12.00 (55,68,69,72,75,77,78,79,81)
Audit studies 7 9.33 (4,16,17,61,63,73,74)
Cross-sectional studies 5 6.67 (15,50,52,56,60)
Case-control studies 3 4.00 (40,64,71)
Correlation studies 3 4.00 (10,29,36)
Case reports 2 2.67 (28,37)
Prospective case-control studies 1 1.33 (76)
Open in a new tab

The articles spanned through a period of 20 years from 2004 to 2023, with gaps of no publications in 2006-2008 and 2010. Notably, 81% of the publications were from 2012 to 2023 (2,4,5,10-23,25-59,61-66,68,81). The year 2021 had the highest number of publications with 14 articles (18.66%) (4,16,20,22,27,29,38,42,45-47,50,75,80), followed by 2015 with 12 articles (16%) (5,10,13,18,21,26,31,37,54,56,66,70), and 2022 with 10 articles (13.3%) (15,17,39,40,48,49,58,61-63). Conversely, 2004, 2005, 2009 and 2011 had the fewest publications, with only one article each (24,60,67,77), followed by 2018 with two articles each (14,71). The average number of articles per year between 2004 and 2023 was 3.75 (Fig. 4). Geographically, the distribution of publications was also uneven. The majority originated from the USA (46 articles) (4,5,10,11,13-15,18-31,33,34,38,40,41,43,47,49,53,56,61-63,65,66,68-73,75,76,78,81), and Germany and China with four and five articles, respectively (35,39,48,58,59,64,74,77,79). Contributions from other countries were fewer (Fig. 5).

Figure 4.

Figure 4

Open in a new tab

Bar chart depicting the number of publications in each year from 2000 to 2023.

Figure 5.

Figure 5

Open in a new tab

World map depicting the countries where quality improvement studies were published and their numbers.

Discussion

QI in healthcare is crucial for various reasons: For enhancing the outcomes of patients, professional development, understanding healthcare challenges at local and national levels, and improving overall system performance. Given the inherent complexities and critical nature of neurosurgery, QI is exceptionally essential, rendering research in this area fundamental (26).

The results of the present study provide key insight into the QI initiatives within the field of neurosurgery. There is an uneven distribution of publications across the main subspecialties of neurosurgery: Adults, pediatrics, spine, cranial and neuro-oncology. This is similar to the findings of other studies and is due to the higher volume of procedures in one field more than the other and/or higher incidence of complications. The findings of the present study, similar to those of other research, also demonstrated a marked disparity in the distribution of targeted patients across the different fields of neurosurgery being more focused on spinal-only (82). The reason for this may be due to low morbidity rates and high efficacy in sustaining therapeutic outcomes of spinal surgery. As a result, this leads to an unintentional bias in the effort of QI research aimed to improve these outcomes and reduce post-operative complications (82). However, the limited attention given to other subspecialties, such as cranial procedures, is concerning. This imbalance is troubling as it may lead to disparities in the quality of care and patient outcomes across different neurosurgical fields. Future QI initiatives should aim to achieve a more equitable distribution of focus across all subspecialties to ensure comprehensive improvements in neurosurgical care (83).

The most common QI interventions are implementing new protocols, audits, ERAS, and data analysis from databases and registries. As was expected, it was found that these QI interventions reflected marked effectiveness in reducing operative complications and improving outcomes (84). However, other implementations may have a crucial impact on neurosurgical care and outcomes that have less QI research focus. For example, improving incident reporting, prediction models and new technologies. It may be beneficial for future studies to explore the impact of the less common interventions and to determine their impact across neurosurgical settings (6).

The findings presented herein highlight several key areas for future research and development in QI for neurosurgery specifically and healthcare in general. There is a need for more balanced attention across all neurosurgical fields particularly in areas, such as pediatrics and neuro-oncology. Expanding the diversity in QI interventions and exploring the efficacy of less common approaches will be crucial for developing comprehensive strategies, techniques and protocols that address the challenges of neurosurgical care.

The present study had some limitations, which should be mentioned. One of the notable limitations encountered during the study was the inability to access several articles due to paywalls. Despite efforts to obtain these publications, seven articles could not be accessed and were therefore excluded from the review. This limitation highlights a common challenge in academic research where financial barriers restrict access to potentially valuable information. Additionally, the scarcity of articles directly addressing the specific aims of this study posed another limitation. The targeted nature of the key words and the niche focus on neurosurgical quality control and improvement meant that there were relatively few articles available that fit the criteria precisely. As a result, it is possible that some relevant articles were not detected during the search process, potentially leading to an incomplete collection of data. This limitation underscores the importance of continued research and publication in this specialized area to build a more robust body of literature for future reviews.

In conclusion, QI studies enhanced care delivery for patients admitted to neurosurgery departments. The findings of the present study demonstrated that these studies were mainly focused on adult neurosurgery and primarily targeted patients who required spinal surgery. Furthermore, the most commonly employed methods to improve the quality of care include the implementation of new protocols, ERAS pathways, data analysis and new or modified checklists. Further research is required to bridge the gap by addressing QI initiatives in cranial surgery and evaluating the effectiveness of less-used modalities, such as new technologies and predictive models.

Acknowledgements

Not applicable.

Funding Statement

Funding: No funding was received.

Availability of data and materials

The data generated in the present study may be requested from the corresponding author.

Authors' contributions

TAS and MMM were involved in the drafting of the manuscript or revising it critically for important intellectual content. TAS, MMM, AMA, NMA, and MA made substantial contributions to the conception or design of the study. MMM, AMA, NMA and MA were involved in the writing of the manuscript and in the literature review. All authors have read and approved the final version of the manuscript.

Ethics approval and consent to participate

Not Applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

  • 1.Backhouse A, Ogunlayi F. Quality improvement into practice. BMJ. 2020;368(m865) doi: 10.1136/bmj.m865. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Westman M, Takala R, Rahi M, Ikonen TS. The need for surgical safety checklists in neurosurgery now and in the future-A systematic review. World Neurosurg. 2020;134:614–628.e3. doi: 10.1016/j.wneu.2019.09.140. [DOI] [PubMed] [Google Scholar]
  • 3.Shirley E. Advancements in neurosurgery and exploring innovations techniques. Perspective. 2024;14(451) [Google Scholar]
  • 4.Neal MT, Richards AE, Curley KL, Lyons MK. Launching a quality improvement project in neurosurgery: How to get started. Interdiscip Neurosurg. 2021;25(101206) [Google Scholar]
  • 5.Witiw CD, Nathan V, Bernstein M. Economics, innovation, and quality improvement in neurosurgery. Neurosurg Clin N Am. 2015;26:197–205. doi: 10.1016/j.nec.2014.11.003. [DOI] [PubMed] [Google Scholar]
  • 6.Hughes RG. Tools and strategies for quality improvement and patient safety. Patient Safety and Quality, 2008. [PubMed] [Google Scholar]
  • 7.Gettelfinger JD, Paulk PB, Schmalbach CE. Patient safety and quality improvement in otolaryngology-head and neck surgery: A systematic review. Laryngoscope. 2021;131:33–40. doi: 10.1002/lary.28538. [DOI] [PubMed] [Google Scholar]
  • 8.Grue B, McGuire C, Hong P, Bezuhly M. Patient safety and quality improvement Initiatives in cleft lip and palate Surgery: A systematic review. J Craniofac Surg. 2023;34:979–986. doi: 10.1097/SCS.0000000000009094. [DOI] [PubMed] [Google Scholar]
  • 9.Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol. 2015;5:238–254. doi: 10.5662/wjm.v5.i4.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Ziewacz JE, McGirt MJ, Chewning SJ Jr. Adverse events in neurosurgery and their relationship to quality improvement. Neurosurg Clin N Am. 2015;26:157–165.vii. doi: 10.1016/j.nec.2014.11.014. [DOI] [PubMed] [Google Scholar]
  • 11.Anderson PA, Savage JW, Vaccaro AR, Radcliff K, Arnold PM, Lawrence BD, Shamji MF. Prevention of surgical site infection in spine surgery. Neurosurgery. 2017;80(3S):S114–S123. doi: 10.1093/neuros/nyw066. [DOI] [PubMed] [Google Scholar]
  • 12.Lindbäck Y, Tropp H, Enthoven P, Abbott A, Öberg B. PREPARE: Presurgery physiotherapy for patients with degenerative lumbar spine disorder: A randomized controlled trial. Spine J. 2018;18:1347–1355. doi: 10.1016/j.spinee.2017.12.009. [DOI] [PubMed] [Google Scholar]
  • 13.McLaughlin N, Jin P, Martin NA. Assessing early unplanned reoperations in neurosurgery: Opportunities for quality improvement. J Neurosurg. 2015;123:198–205. doi: 10.3171/2014.9.JNS14666. [DOI] [PubMed] [Google Scholar]
  • 14.Robertson FC, Logsdon JL, Dasenbrock HH, Yan SC, Raftery SM, Smith TR, Gormley WB. Transitional care services: A quality and safety process improvement program in neurosurgery. J Neurosurg. 2018;128:1570–1577. doi: 10.3171/2017.2.JNS161770. [DOI] [PubMed] [Google Scholar]
  • 15.Pendola G, Koutsouras GW, Piatt J, Kaufman BA, Sandoval-Garcia C, Drapeau AI. Current state and future direction of quality improvement in pediatric neurosurgery: A survey of pediatric neurosurgeons. J Neurosurg Pediatr. 2022;31:186–191. doi: 10.3171/2022.10.PEDS22401. [DOI] [PubMed] [Google Scholar]
  • 16.Ashraf M, Hussain SS, Kamboh UA, Mehboob M, Shahid S, Ashraf N. Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan. J Pak Med Assoc. 2021;71:1515–1520. doi: 10.47391/JPMA.452. [DOI] [PubMed] [Google Scholar]
  • 17.Isaacs AM, Ball CG, Sader N, Muram S, Ben-Israel D, Urbaneja G, Dronyk J, Holubkov R, Hamilton MG. Reducing the risks of proximal and distal shunt failure in adult hydrocephalus: A shunt outcomes quality improvement study. J Neurosurg. 2021;136:877–886. doi: 10.3171/2021.2.JNS202970. [DOI] [PubMed] [Google Scholar]
  • 18.Bekelis K, McGirt MJ, Parker SL, Holland CM, Davies J, Devin CJ, Atkins T, Knightly J, Groman R, Zyung I, Asher AL. The present and future of quality measures and public reporting in neurosurgery. Neurosurg Focus. 2015;39(E3) doi: 10.3171/2015.8.FOCUS15354. [DOI] [PubMed] [Google Scholar]
  • 19.Zuckerman SL, Green CS, Carr KR, Dewan MC, Morone PJ, Mocco J. Neurosurgical checklists: A review. Neurosurg Focus. 2012;33(E2) doi: 10.3171/2012.9.FOCUS12257. [DOI] [PubMed] [Google Scholar]
  • 20.Ali R, Syed S, Sastry RA, Abdulrazeq H, Shao B, Roye GD, Doberstein CE, Oyelese A, Niu T, Gokaslan ZL, Telfeian A. Toward more accurate documentation in neurosurgical care. Neurosurg Focus. 2021;51(E11) doi: 10.3171/2021.8.FOCUS21387. [DOI] [PubMed] [Google Scholar]
  • 21.Asher AL, Parker SL, Rolston JD, Selden NR, McGirt MJ. Using clinical registries to improve the quality of neurosurgical care. Neurosurg Clin N Am. 2015;26:253–263.ix-x. doi: 10.1016/j.nec.2014.11.010. [DOI] [PubMed] [Google Scholar]
  • 22.Kerezoudis P, Kelley PC, Watts CR, Heiderscheit CJ, Roskos MC. Using a data-driven improvement methodology to decrease surgical site infections in a community neurosurgery practice: Optimizing preoperative screening and perioperative antibiotics. World Neurosurg. 2021;149:e989–e1000. doi: 10.1016/j.wneu.2021.01.060. [DOI] [PubMed] [Google Scholar]
  • 23.Sisler L, Omofoye O, Paci K, Hadar E, Goldstein AO, Ripley-Moffitt C. Using lean quality improvement tools to increase delivery of evidence-based tobacco use treatment in hospitalized neurosurgical patients. Jt Comm J Qual Patient Saf. 2017;43:633–641. doi: 10.1016/j.jcjq.2017.06.012. [DOI] [PubMed] [Google Scholar]
  • 24.Deyo RA, Mirza SK. The case for restraint in spinal surgery: Does quality management have a role to play? Eur Spine J 18 Suppl. 2009;3 (Suppl 3):S331–S337. doi: 10.1007/s00586-009-0908-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Ruiz Colón GD, Wu A, Ratliff JK, Prolo LM. Quality and patient safety research in pediatric neurosurgery: A review. Childs Nerv Syst. 2023;39:1147–1158. doi: 10.1007/s00381-022-05821-z. [DOI] [PubMed] [Google Scholar]
  • 26.Yang I, Ung N, Nagasawa DT, Pelargos P, Choy W, Chung LK, Thill K, Martin NA, Afsar-Manesh N, Voth B. Recent advances in the patient safety and quality initiatives movement: Implications for neurosurgery. Neurosurg Clin N Am. 2015;26:301–315.xi. doi: 10.1016/j.nec.2014.11.017. [DOI] [PubMed] [Google Scholar]
  • 27.Stumpo V, Staartjes VE, Quddusi A, Corniola MV, Tessitore E, Schröder ML, Anderer EG, Stienen MN, Serra C, Regli L. Enhanced recovery after surgery strategies for elective craniotomy: A systematic review. J Neurosurg. 2021;135:1857–1881. doi: 10.3171/2020.10.JNS203160. [DOI] [PubMed] [Google Scholar]
  • 28.Wang MC, Boop FA, Kondziolka D, Resnick DK, Kalkanis SN, Koehnen E, Selden NR, Heilman CB, Valadka AB, Cockroft KM, et al. Continuous improvement in patient safety and quality in neurological surgery: The American board of neurological surgery in the past, present, and future. J Neurosurg. 2020;135:637–643. doi: 10.3171/2020.6.JNS202066. [DOI] [PubMed] [Google Scholar]
  • 29.Meyrat R, Vivian E, Shah J, Sridhar A, Hurst BB, Shoup C, Graham RB, Katzen S, Mitchell B, Oh M, Patel NH. Investigating the relationship between ambulatory and hospital patient experience scores in a neurosurgery practice. Healthcare (Basel) 2021;9(1153) doi: 10.3390/healthcare9091153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Tanenbaum JE, Alentado VJ, Miller JA, Lubelski D, Benzel EC, Mroz TE. Association between insurance status and patient safety in the lumbar spine fusion population. Spine J. 2016;17:338–345. doi: 10.1016/j.spinee.2016.10.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Groman R. The relationship between national health care policies and quality improvement in neurosurgery. Neurosurg Clin N Am. 2015;26:167–175.vii-viii. doi: 10.1016/j.nec.2014.11.006. [DOI] [PubMed] [Google Scholar]
  • 32.Hall AJ, Toner NS, Bhatt PM. The introduction of a neurosurgical postoperative checklist improved quality of care and patient safety. Br J Neurosurg. 2019;33:495–499. doi: 10.1080/02688697.2019.1606894. [DOI] [PubMed] [Google Scholar]
  • 33.McLaughlin N, Rodstein J, Burke MA, Martin NA. Demystifying process mapping: A key step in neurosurgical quality improvement initiatives. Neurosurgery. 2014;75:99–109. doi: 10.1227/NEU.0000000000000360. [DOI] [PubMed] [Google Scholar]
  • 34.Shi HH, Chen S, Propester L, Valenzuela J, Gernsback J, Desai VR, Balsara K, Zieles K, Jea A. Influence of the living Pareto chart and data transparency on patient outcomes in neurosurgery. J Neurosurg Pediatr. 2023;31:380–387. doi: 10.3171/2022.12.PEDS22339. [DOI] [PubMed] [Google Scholar]
  • 35.Oszvald Á, Vatter H, Byhahn C, Seifert V, Güresir E. ‘Team time-out’ and surgical safety-experiences in 12,390 neurosurgical patients. Neurosurg Focus. 2012;33(E6) doi: 10.3171/2012.8.FOCUS12261. [DOI] [PubMed] [Google Scholar]
  • 36.Sarnthein J, Stieglitz L, Clavien PA, Regli L. A patient registry to improve patient safety: Recording general neurosurgery complications. PLoS One. 2016;11(e0163154) doi: 10.1371/journal.pone.0163154. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Zuckerman SL, Fargen KM, Mocco J. Neurosurgical checklists: A growing need. Neurosurg Clin N Am. 2015;26:219–229. doi: 10.1016/j.nec.2014.11.009. [DOI] [PubMed] [Google Scholar]
  • 38.Ber R, London D, Senan S, Youssefi Y, Harter DH, Golfinos JG, Pacione D. Perioperative team communication through a mobile app for improving coordination and education in neurosurgery cases. J Neurosurg. 2021;136:1157–1163. doi: 10.3171/2021.4.JNS21485. [DOI] [PubMed] [Google Scholar]
  • 39.Liu B, Liu S, Zheng T, Lu D, Chen L, Ma T, Wang Y, Gao G, He S. Neurosurgical enhanced recovery after surgery ERAS for geriatric patients undergoing elective craniotomy: A review. Medicine (Baltimore) 2022;101(e30043) doi: 10.1097/MD.0000000000030043. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Benjamin CG, Dastagirzada Y, Bevilacqua J, Kurland DB, Fujita K, Sen C, Golfinos JG, Placantonakis DG, Jafar JJ, Lieberman S, et al. The cost effectiveness of implementation of a postoperative endocrinopathy management protocol after resection of pituitary adenomas. J Neurol Surg B Skull Base. 2022;83:618–625. doi: 10.1055/s-0042-1750718. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Norris ZA, Zabat MA, Patel H, Mottole NA, Ashayeri K, Balouch E, Maglaras C, Protopsaltis TS, Buckland AJ, Fischer CR. Multidisciplinary conference for complex surgery leads to improved quality and safety. Spine Deform. 2023;11:1001–1008. doi: 10.1007/s43390-023-00667-0. [DOI] [PubMed] [Google Scholar]
  • 42.Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JL, Fawcett WJ, Ljungqvist O, et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J. 2021;21:729–752. doi: 10.1016/j.spinee.2021.01.001. [DOI] [PubMed] [Google Scholar]
  • 43.Elsarrag M, Soldozy S, Patel P, Norat P, Sokolowski JD, Park MS, Tvrdik P, Kalani MYS. Enhanced recovery after spine surgery: A systematic review. Neurosurg Focus. 2019;46(E3) doi: 10.3171/2019.1.FOCUS18700. [DOI] [PubMed] [Google Scholar]
  • 44.Dietz N, Sharma M, Adams S, Alhourani A, Ugiliweneza B, Wang D, Nuño M, Drazin D, Boakye M. Enhanced recovery after surgery (ERAS) for spine surgery: A systematic review. World Neurosurg. 2019;130:415–426. doi: 10.1016/j.wneu.2019.06.181. [DOI] [PubMed] [Google Scholar]
  • 45.Elayat A, Jena SS, Nayak S, Sahu RN, Tripathy S. ‘Enhanced recovery after surgery-ERAS in elective craniotomies-a non-randomized controlled trial’ BMC. Neurol. 2021;21(127) doi: 10.1186/s12883-021-02150-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Koucheki R, Koyle M, Ibrahim GM, Nallet J, Lebel DE. Comparison of interventions and outcomes of enhanced recovery after surgery: A systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases. Eur Spine J. 2021;30:3457–3472. doi: 10.1007/s00586-021-06984-0. [DOI] [PubMed] [Google Scholar]
  • 47.Kerolus MG, Yerneni K, Witiw CD, Shelton A, Canar WJ, Daily D, Fontes RBV, Deutsch H, Fessler RG, Buvanendran A, O'Toole JE. Enhanced recovery after surgery pathway for single-level minimally invasive transforaminal lumbar interbody fusion decreases length of stay and opioid consumption. Neurosurgery. 2021;88:648–657. doi: 10.1093/neuros/nyaa493. [DOI] [PubMed] [Google Scholar]
  • 48.Wang L, Cai H, Wang Y, Liu J, Chen T, Liu J, Huang J, Guo Q, Zou W. Enhanced recovery after elective craniotomy: A randomized controlled trial. J Clin Anesth. 2022;76(110575) doi: 10.1016/j.jclinane.2021.110575. [DOI] [PubMed] [Google Scholar]
  • 49.Greisman JD, Olmsted ZT, Crorkin PJ, Dallimore CA, Zhigin V, Shlifer A, Bedi AD, Kim JK, Nelson P, Sy HL, et al. Enhanced recovery after surgery (ERAS) for cranial tumor resection: A review. World Neurosurg. 2022;163:104–122.e2. doi: 10.1016/j.wneu.2022.03.118. [DOI] [PubMed] [Google Scholar]
  • 50.Suresh V, Ushakumari PR, Pillai CM, Kutty RK, Prabhakar RB, Peethambaran A. Implementation and adherence to a speciality-specific checklist for neurosurgery and its influence on patient safety. Indian J Anaesth. 2021;65:108–114. doi: 10.4103/ija.IJA_419_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Lepänluoma M, Takala R, Kotkansalo A, Rahi M, Ikonen TS. Surgical safety checklist is associated with improved operating room safety culture, reduced wound complications, and unplanned readmissions in a pilot study in neurosurgery. Scand J Surg. 2014;103:66–72. doi: 10.1177/1457496913482255. [DOI] [PubMed] [Google Scholar]
  • 52.Soriano Sánchez JA, Soriano Solís S, Romero Rangel JAI. Role of the checklist in neurosurgery, a realistic perspective to ‘The need for surgical safety checklists in neurosurgery now and in the future-a systematic review’. World Neurosurg. 2020;134:121–122. doi: 10.1016/j.wneu.2019.10.143. [DOI] [PubMed] [Google Scholar]
  • 53.Lau CY, Greysen SR, Mistry RI, Han SJ, Mummaneni PV, Berger MS. Creating a culture of safety within operative neurosurgery: The design and implementation of a perioperative safety video. Neurosurg Focus. 2012;33(E3) doi: 10.3171/2012.9.FOCUS12244. [DOI] [PubMed] [Google Scholar]
  • 54.Enchev Y. Checklists in neurosurgery to decrease preventable medical errors: A review. Balkan Med J. 2015;32:337–346. doi: 10.5152/balkanmedj.2015.15481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Da Silva-Freitas R, Martín-Laez R, Madrazo-Leal CB, Villena-Martin M, Valduvieco-Juaristi I, Martínez-Agüeros JÁ, Vázquez Barquero A. Establishment of a modified surgical safety checklist for the neurosurgical patient: Initial experience in 400 cases. Neurocirugia (Spain) 2012;23:60–69. doi: 10.1016/j.neucir.2012.04.006. (In Spanish) [DOI] [PubMed] [Google Scholar]
  • 56.Schaffzin JK, Harte L, Marquette S, Zieker K, Wooton S, Walsh K, Newland JG. Surgical site infection reduction by the solutions for patient safety hospital engagement network. Pediatrics. 2015;136:e1353–e1360. doi: 10.1542/peds.2015-0580. [DOI] [PubMed] [Google Scholar]
  • 57.Pauli C, Schwarzbold ML, Diaz AP, De Oliveira Thais MER, Kondageski C, Linhares MN, Guarnieri R, De Lemos Zingano B, Ben J, Nunes JC, et al. Predictors of meaningful improvement in quality of life after temporal lobe epilepsy surgery: A prospective study. Epilepsia. 2017;58:755–763. doi: 10.1111/epi.13721. [DOI] [PubMed] [Google Scholar]
  • 58.Tian B, He Y, Han Z, Liu T, Zhang X. Effect of powdered vancomycin on stopping surgical site wound infections in neurosurgery: A meta-analysis. Int Wound J. 2022;20:1139–1150. doi: 10.1111/iwj.13973. [DOI] [PMC free article] [PubMed] [Google Scholar] [Retracted]
  • 59.Wang J, Ji Y, Wang N, Chen W, Bao Y, Qin Q, Ma C, Xiao Q, Li S. Establishment and validation of a delirium prediction model for neurosurgery patients in intensive care. Int J Nurs Pract. 2020;26(e12818) doi: 10.1111/ijn.12818. [DOI] [PubMed] [Google Scholar]
  • 60.Annette H, Wenström Y. Implementing clinical guidelines for nutrition in a neurosurgical intensive care unit. Nurs Health Sci. 2005;7:266–272. doi: 10.1111/j.1442-2018.2005.00246.x. [DOI] [PubMed] [Google Scholar]
  • 61.Krushelnytskyy MD, Youngblood MW, Lesniak MS, Kemeny HR, Fernandez LG, Burdett KLB, Zhang H, Alden TD, Dahdaleh NS. Optimizing the patient handoff and progress note documentation efficiency in the EPIC EMR system within a neurosurgery residency: A quality improvement initiative. J Clin Neurosci. 2022;105:86–90. doi: 10.1016/j.jocn.2022.09.007. [DOI] [PubMed] [Google Scholar]
  • 62.Kassicieh AJ, Varela S, Rumalla K, Kazim SF, Cole KL, Ghatalia DV, Schmidt MH, Bowers CA. Worse cranial neurosurgical outcomes predicted by increasing frailty in patients with interhospital transfer status: Analysis of 47,736 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019. Clin Neurol Neurosurg. 2022;221(107383) doi: 10.1016/j.clineuro.2022.107383. [DOI] [PubMed] [Google Scholar]
  • 63.Rotter J, Carlstrom LP, Graffeo CS, Nesvick CL, Gunnels M, Hellickson JD, Marcellino C, Atkinson JLD. Streamlining the external ventricular drain and intracranial pressure monitor procedural setup: A quality improvement initiative. World Neurosurg. 2022;166:e475–e483. doi: 10.1016/j.wneu.2022.07.034. [DOI] [PubMed] [Google Scholar]
  • 64.Schipmann S, Akalin E, Doods J, Ewelt C, Stummer W, Suero Molina E. When the infection hits the wound: Matched case-control study in a neurosurgical patient collective including systematic literature review and risk factors analysis. World Neurosurg. 2016;95:178–189. doi: 10.1016/j.wneu.2016.07.093. [DOI] [PubMed] [Google Scholar]
  • 65.Rubiano AM, Puyana JC, Mock CN, Bullock MR, Adelson PD. Strengthening neurotrauma care systems in low and middle income countries. Brain Inj. 2013;27:262–272. doi: 10.3109/02699052.2012.750742. [DOI] [PubMed] [Google Scholar]
  • 66.Fischer C, Petriccione M, Donzelli M, Pottenger E. Improving care in pediatric neuro-oncology patients: An overview of the unique needs of children with brain tumors. J Child Neurol. 2016;31:488–505. doi: 10.1177/0883073815597756. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 67.Bernstein M, Bampoe J. Surgical innovation or surgical evolution: An ethical and practical guide to handling novel neurosurgical procedures. J Neurosurg. 2004;100:2–7. doi: 10.3171/jns.2004.100.1.0002. [DOI] [PubMed] [Google Scholar]
  • 68.Leming-Lee T, Polancich S, Pilon B. The application of the toyota production system LEAN 5S methodology in the operating room setting. Nurs Clin North Am. 2019;54:53–79. doi: 10.1016/j.cnur.2018.10.008. [DOI] [PubMed] [Google Scholar]
  • 69.Hover AR, Sistrunk WW, Cavagnol RM, Scarrow A, Finley PJ, Kroencke AD, Walker JL. Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections. Am J Med Qual. 2014;29:517–521. doi: 10.1177/1062860613505680. [DOI] [PubMed] [Google Scholar]
  • 70.Mathews L, Kla KM, Marolen KN, Sandberg WS, Ehrenfeld JM. Measuring and improving first case on-time starts and analysis of factors predicting delay in neurosurgical operating rooms. J Neurosurg Anesthesiol. 2015;27:203–208. doi: 10.1097/ANA.0000000000000131. [DOI] [PubMed] [Google Scholar]
  • 71.Rupich K, Missimer E, O'Brien D, Shafer G, Wilensky EM, Pierce JT, Kerr M, Kallan MJ, Dolce D, Welch WC. The benefits of implementing an early mobility protocol in postoperative neurosurgical spine patients. Am J Nurs. 2018;118:46–53. doi: 10.1097/01.NAJ.0000534851.58255.41. [DOI] [PubMed] [Google Scholar]
  • 72.Rozman PA, Kurland DB, Golub D, Trang M, Rothstein A, Lewis A, Pacione D. Venous duplex ultrasound surveillance in the neurosurgical population: A single-center quality improvement initiative. World Neurosurg. 2020;144:e80–e86. doi: 10.1016/j.wneu.2020.07.207. [DOI] [PubMed] [Google Scholar]
  • 73.Farrokhi FR, Gunther M, Williams B, Blackmore CC. Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual. 2015;37:277–286. doi: 10.1111/jhq.12053. [DOI] [PubMed] [Google Scholar]
  • 74.Xu Y, Ren X, Shi W, Jiang H. Implementation of the best practice in nasogastric tube feeding of critically ill patients in a neurosurgical intensive care unit. Int J Evid Based Healthc. 2013;11:128–133. doi: 10.1111/1744-1609.12020. [DOI] [PubMed] [Google Scholar]
  • 75.Chang H, Silva MA, Giner A, Ancheta S, Romano JG, Komotar R, Cajigas I. Effects of an external ventricular drain alert protocol on venticulostomy placement time in the emergency department. Neurosurg Focus. 2021;51(E4) doi: 10.3171/2021.8.FOCUS21378. [DOI] [PubMed] [Google Scholar]
  • 76.Joseph J, McLaughlin D, Darian V, Ezeamuzie N. Intraoperative use of low-profile alternating pressure mattress for prevention of hospital-acquired pressure injury. Perioper Care and Oper Room Manage. 2019;17(100080) [Google Scholar]
  • 77.Kantelhardt P, Müller M, Giese A, Rohde V, Kantelhardt SR. Implementation of a critical incident reporting system in a neurosurgical department. Cent Eur Neurosurg. 2011;72:15–21. doi: 10.1055/s-0029-1243199. [DOI] [PubMed] [Google Scholar]
  • 78.Ryan SL, Sen A, Staggers K, Luerssen TG, Jea A. A standardized protocol to reduce pediatric spine surgery infection: A quality improvement initiative. J Neurosurg Pediatr. 2014;14:259–265. doi: 10.3171/2014.5.PEDS1448. Texas Children's Hospital Spine Study Group. [DOI] [PubMed] [Google Scholar]
  • 79.Kantelhardt P, Giese A, Kantelhardt SR. Medication reconciliation for patients undergoing spinal surgery. Eur Spine J. 2016;25:740–747. doi: 10.1007/s00586-015-3878-1. [DOI] [PubMed] [Google Scholar]
  • 80.Licina A, Silvers A, Laughlin H, Russell J, Wan C. Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components. BMC Anesthesiol. 2021;21(74) doi: 10.1186/s12871-021-01281-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81.Young R, Cottrill E, Pennington Z, Ehresman J, Ahmed AK, Kim T, Jiang B, Lubelski D, Zhu AM, Wright KS, et al. Experience with an Enhanced Recovery After Spine Surgery protocol at an academic community hospital. J Neurosurg Spine. 2020;34:680–687. doi: 10.3171/2020.7.SPINE20358. [DOI] [PubMed] [Google Scholar]
  • 82.Kamil M, Muttaqin Z, Hanaya R, Arita K, Yoshimoto K. Bibliometric analysis of the neurosurgery publication productivity of Southeast Asia in 2011-2020. World Neurosurg. 2023;172:e490–e498. doi: 10.1016/j.wneu.2023.01.059. [DOI] [PubMed] [Google Scholar]
  • 83.Hines K, Mouchtouris N, Knightly JJ, Harrop J. A brief history of quality improvement in health care and spinal surgery. Global Spine J. 2020;10 (1_suppl):5S–9S. doi: 10.1177/2192568219853529. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Rock AK, Opalak CF, Workman KG, Broaddus WC. Safety Outcomes Following Spine and Cranial Neurosurgery: Evidence From the National Surgical Quality Improvement Program. J Neurosurg Anesthesiol. 2018;30:328–336. doi: 10.1097/ANA.0000000000000474. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data generated in the present study may be requested from the corresponding author.

Articles from Medicine International are provided here courtesy of Spandidos Publications

RESOURCES