青少年特发性脊柱侧弯后路脊柱融合术患者的加速出院方案可降低术后住院费用22% 。
Accelerated Discharge Protocol for Posterior Spinal Fusion Patients With Adolescent Idiopathic Scoliosis Decreases Hospital Postoperative Charges 22.
作者信息
Sanders Austin E, Andras Lindsay M, Sousa Ted, Kissinger Cathy, Cucchiaro Giovanni, Skaggs David L
机构信息
Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Patient Care Services, Children's Hospital Los Angeles, Los Angeles, CA.
出版信息
Spine (Phila Pa 1976). 2017 Jan 15;42(2):92-97. doi: 10.1097/BRS.0000000000001666.
STUDY DESIGN
A retrospective study of consecutive patients.
OBJECTIVE
The purpose of this study was to determine implementing an accelerated protocol could decrease our average hospital stay and what impact this had on postoperative pain management.
SUMMARY OF BACKGROUND DATA
To our knowledge, no prior studies have reviewed the effect of an accelerated discharge protocol on postoperative pain control for adolescent idiopathic scoliosis (AIS) following posterior spinal fusion.
METHODS
This is a retrospective review of all consecutive patients undergoing posterior spinal fusion (PSF) for AIS before (June 1, 2008-May 31, 2013 = traditional protocol) and after (June 1, 2013-October 22, 2014 = accelerated protocol) protocol implementation. Subjective response to the FACES Pain Intensity scale was collected for each postoperative day while in the hospital by the nursing staff.
RESULTS
There were 194 patients in the traditional pathway and 90 patients in the accelerated pathway. No significant differences in age at surgery, sex, or number of levels fused were present between the groups. Patients managed under the accelerated discharge had an average hospital stay of 3.7 days compared with 5.0 days for the traditional discharge (P < 0.001). There was no increased incidence of wound complications between the two groups [3.6% (7/194) vs. 3.3% (3/90), P = 0.91] or readmission [1.5% (3/194) vs. 4.4% (4/90), P = 0.213]. Hospital charges for postoperative care were significantly less in the accelerated discharge group than in the traditional group ($18,360 vs. $23,640, P < 0.0001). This corresponded to a 22% ($5280/$23,640) decrease in postoperative hospital charges. Patients had a small (<1 point change on FACES pain scale) but statistically significant increase in pain on postoperative days 2, 3, and 4 (P = 0.0001, P = 0.0079, P = 0.0076).
CONCLUSION
Accelerated discharge following PSF for AIS was associated with a 22% decrease in hospital charges in the postoperative period.
LEVEL OF EVIDENCE
研究设计
对连续患者进行的回顾性研究。
目的
本研究旨在确定实施加速方案能否缩短我们的平均住院时间，以及这对术后疼痛管理有何影响。
背景数据总结
据我们所知，此前尚无研究探讨加速出院方案对青少年特发性脊柱侧凸（AIS）后路脊柱融合术后疼痛控制的效果。
方法
这是一项对所有连续接受AIS后路脊柱融合术（PSF）的患者进行的回顾性研究，分为方案实施前（2008年6月1日至2013年5月31日=传统方案）和实施后（2013年6月1日至2014年10月22日=加速方案）两个阶段。住院期间，护理人员每天收集患者对面部疼痛强度量表的主观反应。
结果
传统路径组有194例患者，加速路径组有90例患者。两组患者在手术年龄、性别或融合节段数量上无显著差异。加速出院管理的患者平均住院时间为3.7天，而传统出院患者为5.0天（P<0.001）。两组之间伤口并发症的发生率[3.6%（7/194）对3.3%（3/90），P=0.91]或再入院率[1.5%（3/194）对4.4%（(4/90），P=0.213]均无增加。加速出院组术后护理的医院费用明显低于传统组（18360美元对23640美元，P<0.0001）。这相当于术后医院费用降低了22%（5280美元/23640美元）。患者在术后第2、3和4天的疼痛有小幅增加（面部疼痛量表变化<1分），但具有统计学意义（P=0.0001，P=0.0079，P=0.0076）。
结论
AIS患者PSF术后加速出院与术后住院费用降低22%相关。
证据级别
4级。
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