About Us

The Need

In February 2016, the 1st Annual Safety in Spine Surgery Summit was held in New York City. The response was overwhelming:

  • More than 200 registrants attended from across the US, while 50 more remained on a waiting list.
  • 10 leading medical associations, hospital networks, and research groups endorsed the Summit.
  • 8 medical device companies chose to support the Summit, viewing the topic as vitally important.
  • Numerous requests were received to repeat the meeting in 2017.
    These factors spoke clearly that throughout the field there is a desire to ensure that spinal surgeries are safe and life transforming.


The mission of the Safety in Spine Surgery Project (S3P) is to identify ways to enhance the safety and sustainability of spine surgery and work with stakeholders in spine surgery, including but not limited to patients, providers, payers, and purchasers, to prevent harm.


Spine Surgery is a necessary, beneficial, and cost-effective intervention1,2. However, every year an estimated 60,000 patients are harmed in the course of Spine Surgery3-7. The S3P vision is to reduce the number of patients harmed during and after spine surgery by 50%, from 60,000 to 30,000 by 2023. Preventing harm would generate up to $1 billion in savings to society.

S3P plans on doing this by the following initiatives:

  1. Improving Quality and Reliability
    • Promoting the use of checklists to adhere to best practice guidelines including
      • Preventing surgical site infection
        1. Preventing Surgical Site Infection can generate up to $180,000 in healthcare savings9. Achieving this goal would yield up to $600,000,000 in savings to society.
      • Preventing wrong-level spine surgery
        1. Median malpractice claims associated with wrong-level spine surgery are $75,00011. Achieving this goal would yield up to $45,000,000 in savings to society.
      • Responding to changes in intraoperative neuromonitoring
        1. Median malpractice claims associated with intraoperative neurological injury are $250,000.11 Achieving this goal would yield up to $225,000,000 in savings.
    • Promoting the use of dedicated spine teams across the episode of care
    • Promoting shared decision making with providers and patients through the development and use of educational materials and patient-specific risk severity scores: Use of patient decision aids is associated with 21% reduction in deciding on invasive approaches13
      • Median malpractice claims associated with patient dissatisfaction with final outcomes of surgery are $140,000.13
  2. Preventing unnecessary utilization: Reducing the total number of spine surgeries and avoidable readmissions can prevent overall harm from surgery-related complications and reduce low-value care
    • Ensuring patients are strong enough for surgery through development of framework for implementing risk screening and modifiable risk factor optimization pathways in surgical practices
    • Developing and identifying a network of centers of excellence to deliver reliable and predictable outcomes and costs
      • Certification of providers dedicated to quality and safety
    • Development of payment model frameworks focused on structure, process, and outcomes for working with healthcare stakeholders such as payers, purchasers and malpractice insurers
  3. Advocating for adoption of best practices in spine surgery with stakeholders
    • Promoting standards for quality, safety, and utilization within national societies
    • Promoting the adoption of centers of excellence and payment models with purchasers and payers


  1. Paulus MC, Kalantar SB, Radcliff K. Cost and value of spinal deformity surgery. Spine (Phila Pa 1976). 2014;39(5):388-393. doi:10.1097/BRS.0000000000000150.
  2. McCarthy I, O’Brien M, Ames C, et al. Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus. 2014;36(5):E3. doi:10.3171/2014.3.FOCUS1415.
  3. Lam SK, Pan I-W, Harris DA, Sayama CM, Luerssen TG, Jea A. Patient-, procedure-, and hospital-related risk factors of allogeneic and autologous blood transfusion in pediatric spinal fusion surgery in the United States. Spine (Phila Pa 1976). 2015;40(8):560-569. doi:10.1097/BRS.0000000000000816.
  4. Rajaee SS, Bae HW, Kanim LEA, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37(1):67-76. doi:10.1097/BRS.0b013e31820cccfb.
  5. Reames DL, Smith JS, Fu K-MG, et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976). 2011;36(18):1484-1491. doi:10.1097/BRS.0b013e3181f3a326.
  6. Smith JS, Fu K-MG, Polly DW, et al. Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2010;35(24):2140-2149. doi:10.1097/BRS.0b013e3181cbc8e7.
  7. Fu K-MG, Smith JS, Polly DW, et al. Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database. J Neurosurg Pediatr. 2011;7(1):37-41. doi:10.3171/2010.10.PEDS10212.
  8. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-499. doi:10.1056/NEJMsa0810119.
  9. Emohare O, Ledonio CG, Hill BW, Davis RA, Polly DW, Kang MM. Cost savings analysis of intrawound vancomycin powder in posterior spinal surgery. Spine J. 2014;14(11):2710-2715. doi:10.1016/j.spinee.2014.03.011.
  10. Vitale M, Minkara A, Matsumoto H, et al. Building Consensus: Development of Best Practice Guidelines on Wrong Level Surgery in Spinal Deformity. Spine Deform. 2018;6(2):121-129. doi:10.1016/j.jspd.2017.08.005.
  11. Matsen FA, Stephens L, Jette JL, Warme WJ, Posner KL. Lessons Regarding the Safety of Orthopaedic Patient Care. J Bone Jt Surgery-American Vol. 2013;95(4):e20-1-8. doi:10.2106/JBJS.K.01272.
  12. Sansur CA, Smith JS, Coe JD, et al. Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976). 2011;36(9):E593-7. doi:10.1097/BRS.0b013e3182059bfd.
  13. Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane database Syst Rev. 2014;(1):CD001431. doi:10.1002/14651858.CD001431.pub4.


  • Quality tools are a public good that should be shared widely and freely
  • Safety is a science using rigorous methods from the fields of health services research and implementation science
  • Tools are not enough to produce change. Culture change is critical.

Key Drivers


S3P is committed to engaging with willing partners through rich collaborative improvement, key initiatives, strategic partnership, and services designed to meet the unique local needs of those with whom we work.

Initial Offerings will include:

  • Site Diagnostics—providing an informed view of where an organization is intis improvement journey and delivering a clear roadmap to achieving higher levels of performance & transformation
  • Leadership Coaching—helping surgeon-leaders design engage others to become high-performing teams or mobilize people in complex, dynamic organization towards collective, large-scale systemic change
  • Collaboratives—using shared learning to rapidly test and implement changes that lead to lasting improvement using proven methodologies for change management & culture change including:
    • Exploring hospital-specific organizational factors that distinguish high vs low performance
    • Using multidisciplinary evaluation to decrease utilization of lumbar spine fusion, including development of interdisciplinary spine clinics and indication conferences;
    • Piloting the implementation and spread of lean management in orthopedic practices
  • Wisdom of Crowds—Utilizing practices such as the Delphi method and nominal group technique with leaders in spine surgery to develop best practices. Past work has included:
    • Prevention of Surgical Site Infection in High Risk Spine Surgery
    • Response to Changes in Neuromonitoring during Spine Surgery
    • Prevention of Wrong-level Spine Surgery


Best Practice Guidelines & Videos
Introduction to Safety in Spine Surgery Month
Safety in Spine Surgery Month—Welcome and Introduction by Michael Vitale, MD NewYork-Presbyterian