Quality improvement in degenerative spinal surgery: A systematic review of quality indicators and guideline recommendations

Thesis

Degenerative spinal diseases are among the leading causes of disability worldwide, with a rising prevalence and corresponding increase in treatment demand. Despite this burden, there is a significant variability and uncertainty in surgical decision-making and outcome assessment. There is a growing and compelling need to ensure that care in degenerative spinal surgery is delivered in a patient-centred and value-based manner – and that reliable data is available to prove it. This dissertation constitutes the first systematic review of both existing quality indicators and guideline recommendations in degenerative spinal surgery.

The methodology of this systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Despite the comprehensive search strategy and inclusive eligibility criteria, no studies were identified that reported the development, evaluation or use of quality indicators in degenerative spinal surgery. Guidelines and guideline recommendations were systematically identified, catalogued and appraised using validated instruments. A total of 78 guidelines and 1,641 recommendations were extracted. The guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation Global Rating Scale (AGREE GRS) instrument, while the recommendations were categorised according to Donabedian’s framework and appraised using the Appraisal of Guidelines for Research and Evaluation Recommendation Excellence (AGREE REX) instrument.

The insights derived from this systematic review are intended to serve as a foundation for the translation of guideline recommendations into quality indicators. Ideally, this should be performed by a multidisciplinary expert panel to ensure methodological rigour and clinical relevance. Additionally, the findings of this review may inform spinal registries and help harmonise data collection, thereby strengthening their role as tools for monitoring practice, driving continuous improvements in care delivery and advancing patient outcomes.

Authors: Bouttelgier, R

• Alternative title: Quality improvement in degenerative spinal surgery: A systematic review
• DOI: 10.5287/ora-5zdarabkp
• Type of award: MSc
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: spinal diseases; guideline recommendations; spinal surgery; systematic review; quality indicators; guideline
• Subjects: Systematic reviews (Medical research); Quality; Spinal canal--Diseases