同期和重叠手术：接受脊柱后路器械融合术治疗特发性脊柱侧凸的青少年父母的观点。
Concurrent and Overlapping Surgery: Perspectives From Parents of Adolescents Undergoing Spinal Posterior Instrumented Fusion for Idiopathic Scoliosis.
机构信息
Department of Orthopaedic Surgery, University of California, San Francisco, CA.
School of Medicine, University of California, San Francisco, CA.
出版信息
Spine (Phila Pa 1976). 2019 Jan 1;44(1):53-59. doi: 10.1097/BRS.0000000000002745.
STUDY DESIGN
Prospective cross-sectional survey.
OBJECTIVE
To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation.
SUMMARY OF BACKGROUND DATA
Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers, and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices.
METHODS
A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. "Overlapping" was defined as simultaneity during "noncritical" parts of an operation. "Concurrent" was defined as simultaneity that includes "critical" part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement.
RESULTS
On average, respondents "strongly agree" with the need to be informed about overlapping or concurrent surgery. They "disagree" with both overlapping and concurrent scheduling, and "disagree" with trainees operating without direct supervision, even for "noncritical" parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling.
CONCLUSION
Parents have a strong desire to be informed of simultaneous spinal surgery and anesthesia as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward.
LEVEL OF EVIDENCE
N/A.
研究设计
前瞻性横断面调查。
目的
确定接受青少年特发性脊柱侧凸（AIS）后路器械融合术的患者父母对同期手术和实习生参与的看法。
背景资料总结
同期手术（“同时”）正在受到公众、政府、付款人和医学界的审查。本研究的目的是确定接受青少年特发性脊柱侧凸后路器械融合术的患者父母的看法。我们的目标是用真实的患者和家庭声音为这一主题的全国对话提供信息。
方法
在一家大型学术医疗中心，前瞻性地对 31 名接受青少年特发性脊柱侧凸后路器械融合术的患者的父母进行了一项调查。“重叠”被定义为手术“非关键”部分的同时性。“同时进行”定义为包括手术“关键”部分的同时性。参与者被要求对重叠和同时手术和麻醉以及实习生参与程度表示同意的程度。
结果
平均而言，受访者“强烈同意”有必要告知他们有关重叠或同时手术的情况。他们“不同意”重叠和同时安排，也“不同意”实习生在没有直接监督的情况下操作，即使是“非关键”部分。告知父母有后备外科医生或研究证明同时手术的安全性并不能使他们同意同时安排手术。
结论
父母强烈希望在代表子女进行知情同意时，被告知同时进行的脊柱手术和麻醉。他们不同意同时手术，也不同意实习生在没有直接监督的情况下操作，这表明与当前的指南和实践存在分歧，应该为今后的全国对话提供信息。
证据水平
无。
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