@article{ASJ120525,
author = {Gurjovan Sahi and Aazad Abbas and Jaskaran Singh and Sager Hanna and Nischal Ghimire and Michael Johnson and Stephen Lewis and Jay Toor},
title = {Introducing the spinal invasiveness score to quantify spine surgery wait lists: a stakeholder analysis},
journal = {AME Surgical Journal},
volume = {6},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Spine care delivery faces significant challenges worldwide due to prolonged patient wait times. Conventional waitlist management methods relying solely on patient counts fail to capture case complexity, often leading to inequities where patients requiring complex procedures wait longer than those scheduled for less invasive operations. The Spinal Invasiveness Score (SIS) represents a potential alternative framework that may address these shortcomings. While SIS is a validated system assigning points based on six procedural parameters (anterior/posterior decompression, fusion, and instrumentation), its operational utility in waitlist management requires further exploration. By quantifying surgical complexity, SIS-based waitlists allow stratification by procedure category and enable more accurate comparisons of surgical demand and resource needs. The objective of this study is to explore the perceptions of spine surgeons and healthcare administrators on the benefits, limitations, and potential barriers to SIS adoption in routine clinical practice.Methods: A qualitative descriptive study was conducted surveying spine surgeons and hospital administrators across Canada. Participants reviewed a case study comparing the current waitlist model with the SIS-based approach, were surveyed on their preferred method for wait time calculation, and provided insights on the potential advantages and barriers of adopting SIS. Responses were analyzed using thematic analysis to identify recurring themes around perceived benefits, limitations, and adoption barriers.Results: Among 21 respondents, 17 (81%) favored the SIS approach over the current system. This group included 9 of 11 surgeons and 8 of 10 administrators, showing robust multidisciplinary support. Respondents identified several benefits: (I) enhanced prioritization: quantifying procedural complexity allows waitlist subcategorization (e.g., multi-level vs. single-level), facilitating precise prioritization; (II) improved case triaging: SIS enables efficient triaging based on complexity, allowing providers to allocate resources effectively; (III) better waitlist management: distinguishing between procedure types supports optimal scheduling based on equipment availability. Conversely, identified barriers included the difficulty of capturing SIS scores for each surgery, implementation costs, and SIS not capturing the full clinical complexity of cases such as elevated body mass index (BMI) or revision status.Conclusions: The SIS demonstrates strong potential as an equitable, standardized tool for surgical waitlist management. Stakeholders perceive that by quantifying invasiveness, SIS provides a more accurate reflection of systemic surgical demand than simple patient counts, supporting better resource utilization. Although challenges remain regarding data integration and capturing case complexity beyond invasiveness, early experiences suggest SIS facilitates tailored scheduling solutions, such as allocating longer operating sessions for complex cases. With thoughtful implementation, SIS could improve surgical access and efficiency.},
issn = {2788-578X}, url = {https://asj.amegroups.org/article/view/120525}
}