Floccari Lorena V, Poppino Kiley F, Mundluru Surya N, McIntosh Amy L, Rathjen Karl E, Sucato Daniel J
Akron Children's Hospital, Akron, OH, USA.
Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX, 75219, USA.
Spine Deform. 2020 Oct;8(5):977-981. doi: 10.1007/s43390-020-00136-y. Epub 2020 May 23.
Retrospective case-controlled study.
To analyze the overall performance and outcome of two-a-day surgery days for adolescent idiopathic scoliosis (AIS). As a method to improve efficiency and operating room utilization, some surgeons are now performing two surgeries for AIS in a single day.
A prospectively collected series of AIS patients who underwent posterior spinal fusion on the same day as a second AIS patient by the same surgeon and surgical team were retrospectively reviewed. Patients who underwent same-day surgery (SD) were grouped according to whether they were the first (SD1) or second (SD2) case of the day and were matched (M1 and M2) by surgeon, curve magnitude, Lenke classification, and fusion levels. Comparisons were made: SD1 vs. SD2, SD1 vs. M1, and SD2 vs. M2.
There were 56 patients, with no differences between groups in age, gender, BMI, or curve magnitude (66° vs. 62° vs. 65° vs. 63°). Surgical time was shorter for the SD1 group (17.2 min/level) compared to M1 (20.5 min/level) for a 15% operative time reduction of 44 min (p = 0.008). There were no differences between the groups in curve correction (65.8% vs. 62.8% vs. 66.1% vs. 58.5%), estimated blood loss (EBL), length of stay, or complication rate. One SD2 patient had a malpositioned screw that required revision. There were no other complications.
When performing two AIS surgeries on the same day, surgical time was reduced by 44 min, or 15%, on the first case compared to a matched control. This may be a reflection of the team moving along more efficiently, given the full operative day scheduled. The performance measures of curve correction, EBL, complications, and length of stay did not decline in this new model, and no increased incidence of complications was seen.
回顾性病例对照研究。
分析青少年特发性脊柱侧凸（AIS）一天两台手术的总体表现及结果。作为提高效率和手术室利用率的一种方法，一些外科医生现在一天为AIS患者进行两台手术。
对一系列前瞻性收集的AIS患者进行回顾性分析，这些患者由同一位外科医生和手术团队在同一天与另一位AIS患者一起接受了后路脊柱融合术。接受同日手术（SD）的患者根据其是当天的第一例（SD1）还是第二例（SD2）进行分组，并按外科医生、侧弯度数、Lenke分型和融合节段进行匹配（M1和M2）。进行了以下比较：SD1与SD2、SD1与M1、SD2与M2。
共有56例患者，各分组在年龄、性别、体重指数或侧弯度数方面（66°对62°对65°对63°）无差异。与M1组（20.5分钟/节段）相比，SD1组的手术时间更短（17.2分钟/节段），手术时间减少了44分钟，即15%（p = 0.008）。各分组在侧弯矫正率（65.8%对62.8%对66.1%对58.5%）、估计失血量（EBL）、住院时间或并发症发生率方面无差异。一名SD2患者出现螺钉位置不当，需要翻修。无其他并发症。
同一天进行两台AIS手术时，与匹配的对照组相比，第一例手术的时间减少了44分钟，即15%。鉴于安排了一整天的手术，这可能反映出团队工作效率更高。在这种新模式下，侧弯矫正、EBL、并发症和住院时间等性能指标并未下降，且未观察到并发症发生率增加。
