Brooks Jaysson T, Yaszay Burt, Bartley Carrie E, Bastrom Tracey P, Sponseller Paul D, Shah Suken A, Samdani Amer, Cahill Patrick J, Miyanji Firoz, Newton Peter O
Children's of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA.
Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.
Spine Deform. 2019 Jan;7(1):112-117. doi: 10.1016/j.jspd.2018.06.003.
Retrospective review of a prospective cohort.
To identify patient and surgical factors that alter the length of postoperative intensive care unit (ICU) stays after spinal fusion/instrumentation in patients with neuromuscular scoliosis secondary to cerebral palsy (CP).
High perioperative complication rates in patients with CP contribute to the practice of utilizing the ICU postoperatively for monitoring. However, this is costly and little is known regarding which patients truly need this increased acuity of care.
A prospective, multicenter database was queried for patients with CP who underwent spinal fusion and instrumentation. Patients with an ICU length of stay (LOS) ≤1 day were assumed to not have required postoperative ICU admission. Demographic and surgical characteristics were compared between those with ICU LOS of ≤1 day versus >1 day. A classification and regression tree (CART) analysis was utilized to create a decision algorithm for postoperative ICU admission.
Three hundred twenty-four patients were identified with a mean ICU LOS of 4.7 days (range 0-47). Sixty-eight patients (21%) had an ICU LOS ≤1 day and 256 patients (79%) had an ICU LOS >1 day. CART analysis demonstrated that the institution where the surgery was performed was the primary predictor with two groups: sites that almost routinely had ICU stay >1 day (92%) and those that were split (50.5% >1 day). In the latter group, an operative time greater than 4 hours was a risk factor for a longer ICU stay.
Because of their heterogeneous makeup, CP patients should be evaluated individually and their postoperative disposition should not be based on institutional tradition but instead on objective surgical factors. For those patients with surgical times less than 4 hours, discussions should be held regarding the safety of a postoperative disposition to a regular floor.
Level III.
对前瞻性队列进行回顾性分析。
确定在患有继发于脑性瘫痪（CP）的神经肌肉型脊柱侧弯患者行脊柱融合/内固定术后，影响术后重症监护病房（ICU）住院时长的患者因素和手术因素。
CP患者围手术期并发症发生率高，这促使术后使用ICU进行监测。然而，这成本高昂，且对于哪些患者真正需要这种更高强度的护理知之甚少。
查询一个前瞻性多中心数据库，以获取接受脊柱融合和内固定手术的CP患者。ICU住院时长（LOS）≤1天的患者被认为无需术后入住ICU。比较ICU LOS≤1天和>1天的患者的人口统计学和手术特征。利用分类回归树（CART）分析创建术后ICU入住的决策算法。
共识别出324例患者，平均ICU LOS为4.7天（范围0 - 47天）。68例患者（21%）的ICU LOS≤1天，256例患者（79%）的ICU LOS>1天。CART分析表明，手术实施机构是主要预测因素，分为两组：几乎常规ICU住院>1天的机构（92%）和情况不一的机构（50.5%>1天）。在后一组中，手术时间大于4小时是ICU住院时间延长的危险因素。
由于CP患者构成的异质性，应对其进行个体评估，其术后处置不应基于机构传统，而应基于客观的手术因素。对于手术时间少于4小时的患者，应讨论术后转至普通病房的安全性。
三级。
