Summary Overview of the CHI at Crumlin Spina Bifida Spinal Surgery Clinical Outcomes Review – 27th September 2023

1) Rationale for this internal clinical outcomes review:

• Internal and external clinical outcomes reviews were undertaken at CHI at Temple Street in patients with Spina Bifida who had spinal surgery over the previous 3-5 years, and we published these reviews last week. They were undertaken in response to a number of serious incidents and concerns raised by the multi-professional clinical teams at CHI at Temple Street about the high incidence of complications.
• In the context of these two clinical reviews being carried out at CHI at Temple Street, it was decided in December 2022, in keeping with good quality assurance processes, to conduct an internal clinical outcomes review of a similar cohort of patients at CHI at Crumlin over a similar period of time. It is important to state that there were no clinical concerns being raised by the multi-professional team at CHI at Crumlin at the time.
• CHI management is assured by the results of this review

The clinical outcomes review CHI at Crumlin was commissioned by the Chief Medical Officer of CHI and coordinated by the Research Nurse in Orthopaedics CHI at Crumlin overseen by the Head of Orthopaedic Department CHI at Crumlin. The review was reviewed and approved by the Clinical Director CHI at Crumlin.

2) The clinical outcomes review covered a three-year period from January 2020 to December 2022.

• 11 patients met the criteria for inclusion
• It should be noted that given the low number of patients in this review, that any comparison to other papers in the literature and CHI at Temple Street clinical review data should be interpreted with caution, as the spectrum of surgeries are not necessarily similar.

3) Key findings of the clinical outcomes review were:

• 6 of the 11 patients (55%) developed a postoperative infection with 5 of the 11 (45%) needing to return to theatre for wound management.
• None of the patients had metal work failure following their procedure in this time period or needed replacement of metal work during the review period.
• Other complications included: 1 patient with CNS spinal fluid leak, 1 patient had metal work fragments removed from previous surgery, 1 nutritional deficit and 1 psychological distress.
• No deaths were recorded over the review period

4) Conclusions

• Wound infection was the only significant complication in this cohort. This fell within published rates for Spina Bifida spinal surgery. This has informed recent changes to wound management.
• It was encouraging that there were no metal work failures or need for removal of metal work.
• Members of the CHI Executive have seen the report and are assured by the results. In addition, and important to note, no clinical concerns about spinal surgery outcomes have been raised by the multi-professional teams in CHI at Crumlin to date.