Shrader M Wade, Wood William, Falk Miranda, Segal Lee S, Boan Carla, White Greg
Nemours A.I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
Banner-University Medical Center, Orthopaedic Residency Program, 1111 E McDowell Rd, Phoenix, AZ 85006, USA.
Spine Deform. 2018 Nov-Dec;6(6):730-735. doi: 10.1016/j.jspd.2018.03.002.
Posterior spinal fusion (PSF) in children with cerebral palsy (CP) carries a high risk of complications and morbidity. The purpose of this study is to investigate the impact of using two attending surgeons on blood loss, operative time, and complications in this fragile population.
This was a prospective, matched cohort analysis of patients with CP who underwent PSF with two attending surgeons. These were matched with a control group that had a single-surgeon team, assisted by a senior resident or PA. The groups were compared using paired Student t tests and chi-square tests.
50 patients were included in the study (25 study and 25 matched controls), determined by our power analysis. There was no statistical difference in the mean age, preoperative major curve angle, major curve angle correction, or use of antifibrinolytics. The two-surgeon group decreased surgical time from 5.25 to 3.3 hours (p = .000002), and estimated blood loss from 1,238 to 865 mL (p = .009). The complication rate decreased from 33% to 8% (p=.034). Length of stay was also decreased from 6.5 days to 5.35 (p = .02).
Although confounding variables were present, this study demonstrates that the use of a two-surgeon team during spinal surgery for patients with cerebral palsy could have a role in reducing operative time, blood loss, complication rates, and hospital length of stay. Overall, these factors and any improved operating room efficiencies may lead to lasting improved patient outcomes.
Level III, retrospective, comparative study.
脑瘫（CP）患儿的后路脊柱融合术（PSF）并发症和发病率风险很高。本研究的目的是调查在这个脆弱人群中使用两名主治医生对失血、手术时间和并发症的影响。
这是一项对接受PSF的CP患者进行的前瞻性配对队列分析，由两名主治医生实施手术。这些患者与由一名高级住院医师或医师助理协助的单医生团队对照组进行配对。使用配对t检验和卡方检验对两组进行比较。
根据我们的效能分析，本研究纳入了50例患者（25例研究对象和25例配对对照）。平均年龄、术前主弯角度、主弯角度矫正或抗纤溶药物的使用方面无统计学差异。双医生组将手术时间从5.25小时降至3.3小时（p = .000002），估计失血量从1238毫升降至865毫升（p = .009）。并发症发生率从33%降至8%（p = .034）。住院时间也从6.5天降至5.35天（p = .02）。
尽管存在混杂变量，但本研究表明，在为脑瘫患者进行脊柱手术时使用双医生团队可能在减少手术时间、失血量、并发症发生率和住院时间方面发挥作用。总体而言，这些因素以及手术室效率的任何提高可能会带来持久改善的患者预后。
III级，回顾性比较研究。
