The Spinal Invasiveness Score (Sis) Can Better Quantify Surgical Waitlists Across Canada

Canadian spine care delivery is in a crisis, largely due to inordinate patient wait times. Relying on the current method of a simple count of patients awaiting surgery leads to disproportionate wait time estimations depending on pathology; for example, patients with scoliosis wait disproportionately longer than those for simple discectomies. Using the The Spinal Invasiveness Score (SIS) to categorize surgeries for organization purposes is a comprehensive solution; it is a validated scoring system that assigns points based on surgical invasiveness across six surgical parameters. These surgical parameters include: Anterior decompression, anterior fusion, anterior instrumentation, posterior decompression, posterior fusion and posterior instrumentation. Waitlists can then be calculated based on SIS score, with additional benefits such as subcategorization of wait times and subsequent initiatives to target certain subcategories of procedures. This study evaluates the perceptions of spine surgeons and hospital administrators regarding the adoption of SIS for spine surgery waitlist management in Canada, focusing on benefits, limitations, and barriers to implementation. 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 and were surveyed on their preferred method for wait time calculation and asked for insights on the potential advantages and barriers of adopting SIS. Responses were analyzed using thematic analysis to identify recurring themes around SIS's perceived benefits, limitations, and barriers to adoption. 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 support across disciplines. Respondents identified several benefits of the SIS approach: Enhanced Prioritization: The SIS model's ability to quantify procedural complexity allows for the subcategorization of waitlists (e.g., multi-level vs. single-level surgeries), facilitating more precise case prioritization. Improved Case Triaging: The SIS system enables more efficient triaging of surgeries based on their complexity, allowing healthcare providers to allocate resources more effectively. Better Waitlist Management: By distinguishing between different types of procedures (e.g., instrumented vs. non-instrumented), the SIS approach supports optimal scheduling and resource distribution. However, barriers identified included difficulty for the health system to capture SIS score for each surgery, cost of implementation and SIS not capturing full complexity of cases such as elevated BMI or revision status. The SIS method received strong support from stakeholders, demonstrating its potential to improve spine surgery waitlist management in Canada. The method allows for more accurate, standardized wait time calculations and better resource allocation. While barriers such as data capture challenges, implementation costs, and limited representation of complex cases remain, the positive feedback suggests that SIS is a viable tool for enhancing current practices. A pilot study in a provincial spine program has shown early success in advocating for more tailored OR scheduling, such as longer OR days to accommodate complex surgeries. With careful implementation and adaptation, SIS could become a key part of nationwide waitlist management strategies.