Heller Aaron, Melvani Roshan, Thome Andrew, Leamon Julia, Schwend Richard M
Department of Orthopedic Surgery, Children's Mercy Hospital, University of Missouri Kansas City, Kansas City, Missouri, USA.
J Pediatr Orthop B. 2016 May;25(3):258-62. doi: 10.1097/BPB.0000000000000274.
The most common corrective surgery for adolescent idiopathic scoliosis (AIS) is posterior instrumented spinal fusion, which is a relatively lengthy procedure. Longer procedures are known to have higher rates of negative outcomes and higher economic costs across the surgical specialties. The purpose of this study is to identify the factors that influence the length of this operation in AIS patients. This was an institutional review board-approved, retrospective cohort study. All primary posterior instrumented arthrodesis procedures in 2011-2013 performed by three surgeons on AIS patients at a tertiary care hospital were included. Age, race, sex, BMI, Cobb angle, curve flexibility, Lenke classification, number of levels fused, number of screws used, osteotomy use, intraoperative O-arm use, and length of surgery (time from incision to closure) were obtained from the electronic medical record. Multivariable linear regression analysis was used to determine independent predictors of length of surgery, and standardized regression coefficients were calculated to compare the relative magnitude of significant variables. A total of 95 procedures were included. The average length of surgery was 375 ± 72.7 min. The multivariable linear regression analysis contained the variables Cobb angle, number of screws used, osteotomy use, Lenke curve type, surgeon, patient age, and sex. The regression identified the number of screws used [β=4.72, P=0.003, 95% confidence interval (CI) 1.7-7.8], osteotomy use (β = 50.2, P = 0.004, 95% CI 16.2-84.1), Lenke type 3 curve (β = 77.9, P = 0.001, 95% CI 31.7-174), male sex (β=62.5, P=0.003, 95% CI 21.5-103), the Cobb angle (β=1.04, P=0.045, 95% CI 0.02-2.1), and the surgeon (β = 75.2, P < 0.0001, 95% CI 40-110) as independently associated with the length of surgery. The most significant factor associated with operative duration was the surgeon performing the case. We identified male sex, number of screws used, Lenke type 3 curves, osteotomy use, Cobb angle, and the surgeon variable as significantly associated with increased length of surgery in posterior arthrodesis of AIS patients.
青少年特发性脊柱侧凸（AIS）最常见的矫正手术是后路器械辅助脊柱融合术，这是一个相对耗时较长的手术。众所周知，在各个外科专业中，手术时间越长，出现负面结果的几率越高，经济成本也越高。本研究的目的是确定影响AIS患者该手术时长的因素。这是一项经机构审查委员会批准的回顾性队列研究。纳入了2011年至2013年期间三位外科医生在一家三级护理医院为AIS患者实施的所有初次后路器械辅助关节融合术。从电子病历中获取年龄、种族、性别、体重指数（BMI）、 Cobb角、曲线柔韧性、Lenke分类、融合节段数、使用的螺钉数量、是否进行截骨术、术中是否使用O型臂以及手术时长（从切口到缝合的时间）。采用多变量线性回归分析来确定手术时长的独立预测因素，并计算标准化回归系数以比较显著变量的相对大小。共纳入95例手术。平均手术时长为375±72.7分钟。多变量线性回归分析纳入了Cobb角、使用的螺钉数量、是否进行截骨术、Lenke曲线类型、外科医生、患者年龄和性别等变量。回归分析确定使用的螺钉数量[β = 4.72，P = 0.003，95%置信区间（CI）1.7 - 7.8]、是否进行截骨术（β = 50.2，P = 0.004，95% CI 16.2 - 84.1）、Lenke 3型曲线（β = 77.9，P = 0.001，95% CI 31.7 - 174）、男性性别（β = 62.5，P = 0.003，95% CI 21.5 - 103）、Cobb角（β = 1.04，P = 0.045，95% CI 0.02 - 2.1）以及外科医生（β = 75.2，P < 0.0001，95% CI 40 - 110）与手术时长独立相关。与手术持续时间最相关的因素是实施该病例的外科医生。我们确定男性性别、使用的螺钉数量、Lenke 3型曲线、是否进行截骨术、Cobb角以及外科医生变量与AIS患者后路关节融合术手术时长增加显著相关。
