手术等待时间对脊柱侧弯手术的影响：外科医生的观点

Impact of Surgical Waiting-List Times on Scoliosis Surgery: The Surgeon's Perspective.

作者信息

Miyanji Firoz, Newton Peter O, Samdani Amer F, Shah Suken A, Varghese Ranjit A, Reilly Christopher W, Mulpuri Kishore

机构信息

*Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada †Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada ‡Department of Orthopaedic Surgery, University of California, San Diego, CA §Department of Orthopaedics, Rady Children's Hospital, San Diego, CA ¶Shriners Hospitals for Children, Philadelphia, PA; and ‖Department of Orthopaedics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE.

出版信息

Spine (Phila Pa 1976). 2015 Jun 1;40(11):823-8. doi: 10.1097/BRS.0000000000000205.

DOI:10.1097/BRS.0000000000000205

PMID:24430712

Abstract

STUDY DESIGN

Survey.

OBJECTIVE

The aim of this study was to evaluate the surgeon's perspective on the potential impact of prolonged surgical waitlists on the surgical care and perioperative management of patients with scoliosis.

SUMMARY OF BACKGROUND DATA

The long waits for surgical treatment of scoliosis found in some countries may have serious implications for the complexity of surgery and perioperative care required if the curve progresses while waiting. The surgeon's perspective on this problem provides important information that needs to be taken into account during resource allocation.

METHODS

Radiographs from 13 patients who had waited more than 6 months for scoliosis surgery were selected. Each patient had radiographs from the time of surgical booking and immediately preoperatively. The radiographs and a questionnaire were sent to 3 surgeons to canvass their surgical and postoperative plan. The surgeons were blinded to the fact that the radiographs were of the same patients at 2 time points. The patients' actual course of treatment was documented.

RESULTS

Data for 11 patients were available for analysis. The average wait for surgery was 24 months (range, 17-30 mo). The mean curve progression was 25.3° while on the waitlist, from an average of 52° to 77°. By the time the patients had to undergo surgery, more anterior releases were added to posterior instrumentation alone in the surgical plan. Mean estimated operative time increased by 2.2 hours, mean estimated length of hospital stay increased by 1 day, and the estimated level of difficulty of surgery increased 2.33 grades. The predicted estimated blood loss also increased.

CONCLUSION

From the surgeon's perspective, lengthy waitlists have a significant negative impact on the perioperative and postoperative care of patients with scoliosis by increasing the complexity of surgery. The actual course of treatment corresponded to the responses from these different surgeons.

LEVEL OF EVIDENCE

N/A.

摘要

研究设计

调查。

目的

本研究旨在评估外科医生对于手术等待名单延长对脊柱侧弯患者手术治疗及围手术期管理潜在影响的看法。

背景数据总结

在一些国家发现，脊柱侧弯手术治疗的漫长等待时间可能会对等待期间侧弯进展时所需手术的复杂性和围手术期护理产生严重影响。外科医生对该问题的看法为资源分配时需要考虑的重要信息。

方法

选取13例等待脊柱侧弯手术超过6个月患者的X光片。每位患者均有手术预约时及术前即刻的X光片。将X光片及一份问卷发给3位外科医生，征求他们的手术及术后计划。外科医生对X光片是同一患者在两个时间点的情况不知情。记录患者实际治疗过程。

结果

11例患者的数据可供分析。平均手术等待时间为24个月（范围17 - 30个月）。等待名单期间平均侧弯进展为25.3°，从平均52°进展至77°。到患者必须接受手术时，手术计划中在单纯后路器械固定基础上增加了更多前路松解。平均预计手术时间增加2.2小时，平均预计住院时间增加1天，预计手术难度等级增加2.33级。预计失血量也增加。