Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Handayama Higashi-ku, Hamamatsu-shi, Shizuoka prefecture, Japan.
Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Spine (Phila Pa 1976). 2020 Mar 15;45(6):381-389. doi: 10.1097/BRS.0000000000003274.
Retrospective study from a prospectively collected database.
To compare the perioperative outcome between after-hours and daytime surgery carried out by a dedicated spinal deformity team for severe Idiopathic Scoliosis (IS) patients with Cobb angle ≥ 90°.
There were concerns that after-hours corrective surgeries in severe IS have higher morbidity compared to daytime surgeries.
Seventy-one severe IS patients who underwent single-staged Posterior Spinal Fusion (PSF) were included. Surgeries performed between 08:00H and 16:59H were classified as "daytime" group and surgeries performed between 17:00H and 06:00H were classified as "after-hours" group. Perioperative outcome parameters were average operation start time and end time, operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, blood transfusion rate, total patient-controlled anesthesia (PCA) morphine usage, length of postoperative hospitalization, and complications. Radiological variables assessed were preoperative and postoperative Cobb angle, side bending flexibility, number of fusion levels, number of screws used, Correction Rate, and Side Bending Correction Index.
Thirty patients were operated during daytime and 41 patients were operated after-hours. The mean age was 16.1 ± 5.8 years old. The mean operation start time for daytime group was 11:31 ± 2:45H versus 19:10 ± 1:24H for after-hours group. There were no significant differences between both groups in the operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, postoperative hemoglobin, hemoglobin drift, transfusion rate, length of postoperative hospitalization, postoperative Cobb angle, Correction Rate, and Side Bending Correction Index. There were four complications (1 SSEP loss, 1 massive blood loss, and 2 superficial wound infections) with no difference between daytime and after-hours group.
After-hours elective spine deformity corrective surgeries in healthy ambulatory patients with severe IS performed by a dedicated spinal deformity team using dual attending surgeon strategy were as safe as those performed during daytime.
一项前瞻性数据库回顾性研究。
比较由专门的脊柱畸形团队为严重特发性脊柱侧凸（IS）患者（Cobb 角≥90°）进行夜间和日间手术的围手术期结果。
有人担心，在严重 IS 中进行夜间矫形手术比日间手术的发病率更高。
共纳入 71 例接受一期后路脊柱融合术（PSF）的严重 IS 患者。08:00 至 16:59 进行的手术被分类为“日间”组，17:00 至 06:00 进行的手术被分类为“夜间”组。围手术期结果参数包括平均手术开始时间和结束时间、手术持续时间、术中失血量、术中血液动力学参数、术前和术后血红蛋白、输血率、总患者自控镇痛（PCA）吗啡用量、术后住院时间和并发症。评估的影像学变量包括术前和术后 Cobb 角、侧弯曲灵活性、融合节段数、使用的螺钉数、矫正率和侧弯曲矫正指数。
30 例患者在日间手术，41 例患者在夜间手术。平均年龄为 16.1±5.8 岁。日间组的平均手术开始时间为 11:31±2:45H，夜间组为 19:10±1:24H。两组在手术持续时间、术中失血量、术中血液动力学参数、术后血红蛋白、血红蛋白漂移、输血率、术后住院时间、术后 Cobb 角、矫正率和侧弯曲矫正指数方面均无显著差异。日间组和夜间组各有 4 例并发症（1 例 SSEP 丧失、1 例大量失血、2 例浅表伤口感染），无差异。
由专门的脊柱畸形团队采用双主治医生策略为健康门诊患者进行的严重 IS 夜间择期脊柱矫正手术与日间手术一样安全。
4 级。
