Without doubt, the impact of complications like surgical site infection (SSI) can have a tremendous burden on patients, their families, surgeons, hospitals, and society as a whole. As with most complications in healthcare, SSI should be thought of as the result of a combination of host, technique, systems and culture challenges. When multiple defects accumulate, SSI overwhelms the various countermeasures and a clinical infection ensures.

When the defects all align, it allows for these factors to allow passage through the “Swiss cheese” of host, perioperative, and systems defenses. Our role in making care better extends far beyond the time in the operating room. Our highest performance can only come from the ability to develop a high functioning team with unique and synergistic inputs across the entire care continuum, starting well ahead of surgery to include culture and involvement of multiple stakeholders all working towards a shared goal with everyone understanding the importance of the role they play. The greatest opportunity to improve quality, safety, and value lies in the period before the skin incision and long after it is closed. Increasingly, it’s not just the surgeon’s role in acting as the captain of the ship but understanding the importance of “slowing the machine” to consider the full spectrum and extent of potential surgical risk and working with the team to attempt to optimize preoperative care and potentially alter the characteristics of the surgical approach for a given patient.

Work at S3P is dedicated to exploring the role of the multidisciplinary team in minimizing the possibility of complications after spine surgery. Interventions and risks are being explored as efforts to affect the host, surgical technique, culture and systems of care. As with all quality improvement efforts, these must adapt over time to create sustained and iterative improvements in care. Our team began this journey several years ago and we look forward to involving you in this as well.