后路手术可安全用于 AIS 患者，不会影响影像学或围手术期结果：一项 10 年回顾。
Back-to-Back Surgeries in AIS Patients Can be Performed Safely Without Compromising Radiographic or Perioperative Outcomes: A 10-year Review.
机构信息
Department of Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY.
Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY.
出版信息
Spine (Phila Pa 1976). 2020 Jan 1;45(1):26-31. doi: 10.1097/BRS.0000000000003172.
STUDY DESIGN
A retrospective chart review of prospectively collected data.
OBJECTIVE
The aim of this study was to determine whether back-to-back scoliosis surgeries can be performed safely without compromising outcomes and the reproducibility of the practice between institutions.
SUMMARY OF BACKGROUND DATA
During the summer, spinal surgeons will often book multiple cases in one day. The complexity and demands of spinal fusion surgery call into question the safety. Change of operating room staff including anesthesiologists, nurses, and neurologists may introduce new risks.
METHODS
From 2009 to 2018, index AIS surgeries were included. In Groups 1, 2, and 3, surgeries were performed by a single surgeon. In Group 4, they were performed by other institutional surgeons. Group 1: first surgery of the day, Group 2: second surgery of the day, Group 3: only surgery of the day, Group 4: only surgery of the day by different institutional surgeon. Additional analysis was done to determine reproducibility after a surgeon was moved from Institution 1 to Institution 2.
RESULTS
Five hundred sixty-seven AIS patients were analyzed. Group 1 patients had similar radiographic outcomes compared with Group 2 (P > 0.05). Surgical time was similar (P = 0.51), but significantly more levels fused (P = 0.01). Compared with Group 3, Group 2 had a smaller preoperative Cobb (P = 0.02), shorter surgeries (P < 0.001), and length of stay (P = 0.04) but similar complication rate (P = 1). Compared with Group 4, Group 2 had smaller preoperative Cobb (P < 0.001), shorter surgery, and lower complication rate (P = 0.03). When determining reproducibility, institution 2 patients had significantly less blood loss, shorter surgeries, and shorter lengths of stay (P < 0.05).
CONCLUSION
Although long and involved, back-to-back AIS surgeries do not compromise radiographic or perioperative outcomes. Changes in operating team do not appear to impact safety, efficiency, or outcomes. This study also found that the practice is reproducible between institutions.
LEVEL OF EVIDENCE
研究设计
前瞻性收集数据的回顾性图表审查。
目的
本研究旨在确定是否可以安全地进行连续的脊柱侧弯手术，而不会影响结果和机构之间实践的可重复性。
背景资料概要
在夏季，脊柱外科医生通常会在一天内预约多个病例。脊柱融合手术的复杂性和要求对安全性提出了质疑。手术室工作人员（包括麻醉师、护士和神经科医生）的变动可能会带来新的风险。
方法
从 2009 年到 2018 年，纳入了索引 AIS 手术。在第 1、2 和 3 组中，手术由一名外科医生进行。在第 4 组中，手术由其他机构的外科医生进行。第 1 组：当天的第一台手术，第 2 组：当天的第二台手术，第 3 组：当天唯一的手术，第 4 组：当天由不同机构外科医生进行的唯一手术。还进行了额外的分析，以确定在外科医生从机构 1 转移到机构 2 后的可重复性。
结果
共分析了 567 例 AIS 患者。第 1 组患者的影像学结果与第 2 组相似（P>0.05）。手术时间相似（P=0.51），但融合的节段明显更多（P=0.01）。与第 3 组相比，第 2 组术前 Cobb 角较小（P=0.02），手术时间较短（P<0.001），住院时间较短（P=0.04），但并发症发生率相似（P=1）。与第 4 组相比，第 2 组术前 Cobb 角较小（P<0.001），手术时间较短，并发症发生率较低（P=0.03）。在确定可重复性时，机构 2 的患者出血量明显减少，手术时间和住院时间更短（P<0.05）。
结论
尽管时间长且复杂，但连续的 AIS 手术不会影响影像学或围手术期结果。手术团队的变化似乎不会影响安全性、效率或结果。本研究还发现，该实践在机构之间具有可重复性。
证据水平
3 级
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