Fulkerson Daniel H, Vachhrajani Shobhan, Brayton Alison, Kulkarni Abhaya V, Jea Andrew
NeuroSpine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Tex., USA.
Pediatr Neurosurg. 2010;46(3):213-20. doi: 10.1159/000319364. Epub 2010 Nov 4.
BACKGROUND/AIMS: The perception of a surgical complication may differ between surgeons and patients. In pediatric spine surgery, the perception of the parent or primary caregiver may also differ. In order to better define these relationships, we performed a pilot study surveying a convenience sample of pediatric spinal surgeons, patients and their parent or primary caregiver. We hope to use this initial pilot study as a starting point for future research into this incompletely defined, yet increasingly relevant topic.
A survey of case vignettes describing a potential perioperative complication was administered to 14 pediatric spine surgeons at the Texas Children's Hospital Pediatric NeuroSpine Clinic from June 1 to July 31, 2009. The same survey, with modified language, was presented to a group of 13 pediatric patients (age range: 12-18 years). In addition, the surveys were separately presented to 34 primary caregivers of pediatric patients evaluated in a spine surgery clinic. The 61 respondents were asked to evaluate the cases and determine if there was a minor, a major or no complication present. Fisher's exact test was employed to evaluate associations of respondent groups and complication severity.
There were no statistically significant differences in the proportion of patients and caregivers rating the presence of complications. In 8 of 13 cases, a majority of surgeons and a majority of patients/caregivers felt a complication was present (all p > 0.06). A greater proportion of surgeons than patients/caregivers felt a complication was present in 2 cases of transient neurological deficit/paraparesis (6 weeks to 6 months; p < 0.04) and 1 case of cosmetically significant pressure sores to the face (p = 0.0002). A greater proportion of patients/caregivers identified a complication in a loss of range of motion after occipitocervical fusion (p < 0.0001) and a loss of motor evoked potentials without a neurological deficit. Amongst those who identified a complication, a greater proportion of surgeons considered the following as a 'major' complication: malpositioned spinal instrumentation with a return to the operating room (p = 0.02); transient new neurological deficit (p < 0.01), and deep wound infection with return to the operating room (p < 0.01). In no scenario did a greater proportion of patients/caregivers consider the complication 'major' compared to surgeons.
In this pilot study, there appear to be differences in how postoperative complications are perceived by surgeons when compared to patients/caregivers. The importance of reconciling such differing opinions through open discussions between surgeons, patients and their families is integral to ensure congruent expectations of planned surgical interventions.
背景/目的：外科医生和患者对外科手术并发症的认知可能存在差异。在小儿脊柱手术中，患儿家长或主要照料者的认知也可能不同。为了更好地明确这些关系，我们进行了一项试点研究，对小儿脊柱外科医生、患者及其家长或主要照料者的便利样本进行了调查。我们希望将这项初步试点研究作为一个起点，用于未来对这个定义不明确但日益相关的主题的研究。
2009年6月1日至7月31日，在德克萨斯儿童医院小儿神经脊柱诊所，对14名小儿脊柱外科医生进行了一项关于描述潜在围手术期并发症的病例 vignette 的调查。对一组13名小儿患者（年龄范围：12 - 18岁）进行了相同的调查，但语言经过修改。此外，将这些调查分别呈现给在脊柱外科诊所接受评估的34名小儿患者的主要照料者。61名受访者被要求评估这些病例，并确定是否存在轻微、严重或无并发症。采用 Fisher 精确检验来评估受访者群体与并发症严重程度之间的关联。
在对并发症存在情况进行评级的患者和照料者比例方面，没有统计学上的显著差异。在13个病例中的8个病例中，大多数外科医生和大多数患者/照料者都认为存在并发症（所有p>0.06）。在2例短暂性神经功能缺损/轻瘫（6周至6个月）和1例面部有明显美容影响的压疮病例中，认为存在并发症的外科医生比例高于患者/照料者（p<0.04和p = 0.0002）。在枕颈融合术后活动范围丧失以及运动诱发电位丧失但无神经功能缺损的病例中，患者/照料者识别出并发症的比例更高（p<0.0001）。在那些识别出并发症的人中，更大比例的外科医生将以下情况视为“严重”并发症：脊柱内固定位置不当并返回手术室（p = 0.02）；短暂性新的神经功能缺损（p<0.01），以及深部伤口感染并返回手术室（p<0.01）。在任何情况下，认为并发症“严重”的患者/照料者比例都没有高于外科医生。
在这项试点研究中，与患者/照料者相比，外科医生对术后并发症的认知似乎存在差异。通过外科医生、患者及其家属之间的公开讨论来协调这些不同意见的重要性，对于确保对计划手术干预的一致期望至关重要。
