成人脊柱侧弯畸形手术：一名与两名主刀医生手术效果的比较
Adult Scoliosis Deformity Surgery: Comparison of Outcomes Between One Versus Two Attending Surgeons.
作者信息
Gomez Jaime A, Lafage Virginie, Sciubba Daniel M, Bess Shay, Mundis Gregory M, Liabaud Barthelemy, Hanstein Regina, Shaffrey Christopher, Kelly Michael, Ames Christopher, Smith Justin S, Passias Peter G, Errico Thomas, Schwab Frank
机构信息
Department of Orthopedic Surgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
Hospital for Joint Diseases, New York University, New York, NY.
出版信息
Spine (Phila Pa 1976). 2017 Jul 1;42(13):992-998. doi: 10.1097/BRS.0000000000002071.
STUDY DESIGN
Retrospective review of prospectively collected data.
OBJECTIVE
Assess outcomes of adult spinal deformity (ASD) surgery performed by one versus two attending surgeons.
SUMMARY OF BACKGROUND DATA
ASD centers have developed two attending teams to improve efficiency; their effects on complications and outcomes have not been reported.
METHODS
Patients with ASD with five or more levels fused and more than 2-year follow-up were included. Estimated blood loss (EBL), length of stay (LOS), operating room (OR) time, complications, quality of life (Health Related Quality of Life), and x-rays were analyzed. Outcomes were compared between one-surgeon (1S) and two-surgeon (2S) centers. A deformity-matched cohort was analyzed.
RESULTS
A total of 188 patients in 1S and 77 in 2S group were included. 2S group patients were older and had worse deformity based on the Scoliosis Research Society-Schwab classification (P < 0.05). There were no significant differences in levels fused (P = 0.57), LOS (8.7 vs 8.9 days), OR time (445.9 vs 453.2 min), or EBL (2008 vs 1898 cm; P > 0.05). 2S patients had more three-column osteotomies (3CO; P < 0.001) and used less bone morphogenetic protein 2 (BMP-2; 79.9% vs 15.6%; P < 0.001). The 2S group had fewer intraoperative complications (1.3% vs 11.1%; P = 0.006). Postoperative (6 wk to 2 yr) complications were more frequent in the 2S group (4.8% vs 15.6%; P < 0.002). After matching for deformity, there were no differences in (9.1 vs 10.1 days), OR time (467.8 vs 508.4 min), or EBL (3045 vs 2247 cm; P = 0.217). 2S group used less BMP-2 (20.6% vs 84.8%; P < 0.001), had fewer intraoperative complications (P = 0.015) but postoperative complications due to instrumentation failure/pseudarthrosis were more frequent (P < 0.01).
CONCLUSION
No significant differences were found in LOS, OR time, or EBL between the 1S and 2S groups, even when matching for severity of deformity. 2S group had less BMP-2 use, fewer intraoperative complications but more postoperative complications.
LEVEL OF EVIDENCE
研究设计
对前瞻性收集的数据进行回顾性分析。
目的
评估由一名主治医生与两名主治医生实施的成人脊柱畸形（ASD）手术的结果。
背景数据总结
ASD治疗中心已组建了两个主治医生团队以提高效率；尚未有关于其对并发症和手术结果影响的报道。
方法
纳入融合节段达五级或以上且随访时间超过2年的ASD患者。分析估计失血量（EBL）、住院时间（LOS）、手术室（OR）时间、并发症、生活质量（健康相关生活质量）及X线检查结果。比较单主刀（1S）中心与双主刀（2S）中心的手术结果。分析了一个畸形匹配队列。
结果
1S组共纳入188例患者，2S组纳入77例患者。根据脊柱侧凸研究学会-施瓦布分类法，2S组患者年龄更大，畸形更严重（P<0.05）。融合节段数量（P = 0.57）、住院时间（8.7天对8.9天）、手术室时间（445.9分钟对453.2分钟）或估计失血量（2008毫升对1898毫升；P>0.05）方面无显著差异。2S组患者接受三柱截骨术（3CO）的比例更高（P<0.001），骨形态发生蛋白2（BMP-2）的使用量更少（79.9%对15.6%；P<0.001）。2S组术中并发症更少（1.3%对11.1%；P = 0.006）。术后（6周-2年）并发症在2S组更为常见（4.8%对15.6%；P<0.002）。在对畸形进行匹配后，住院时间（9.1天对10.1天）、手术室时间（467.8分钟对508.4分钟）或估计失血量（3045毫升对2247毫升；P = 0.217）方面无差异。2S组BMP-2的使用量更少（20.6%对84.8%；P<0.001），术中并发症更少（P = 0.015），但因器械故障/假关节导致的术后并发症更常见（P<0.01）。
结论
即使在对畸形严重程度进行匹配后，1S组和2S组在住院时间、手术室时间或估计失血量方面未发现显著差异。2S组BMP-2使用量更少，术中并发症更少，但术后并发症更多。
证据等级
2级
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