Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Spine (Phila Pa 1976). 2021 Jun 15;46(12):E663-E670. doi: 10.1097/BRS.0000000000003866.
Retrospective study.
To assess the learning curve of a dual attending surgeon strategy in severe adolescent idiopathic scoliosis patients.
The advantages of a dual attending surgeon strategy in improving the perioperative outcome in scoliosis surgery had been reported. However, the learning curve of this strategy in severe scoliosis had not been widely studied.
A total of 105 patients with adolescent idiopathic scoliosis with Cobb angle of 90° or greater, who underwent posterior spinal fusion using a dual attending surgeon strategy were recruited. Primary outcomes were operative time, total blood loss, allogeneic blood transfusion requirement, length of hospital stay from time of operation and perioperative complications. Cases were sorted chronologically into group 1: cases 1 to 35, group 2: cases 36 to 70, and group 3: case 71 to 105. Mean operative time (≤193.3 min), total blood loss (≤1612.2 mL), combination of both and allogeneic blood transfusion were the selected criteria for receiver operating characteristic analysis of the learning curve.
The mean Cobb angle was 104.5° ± 12.3°. The operative time, total blood loss, and allogeneic blood transfusion requirement reduced significantly for group 1 (220.6 ± 54.8 min; 2011.3 ± 881.8 mL; 12 cases) versus group 2 (183.6 ± 36.7 min; 1481.6 ± 1035.5 mL; 3 cases) and group 1 versus group 3 (175.6 ± 38.4 min; 1343.7 ± 477.8 mL; 3 cases) (P < 0.05). There were six perioperative complications. Fifty-seven cases were required to achieve the preset criteria (mean operative time and mean total blood loss) (area under the curve 0.740; P < 0.001; sensitivity 0.675; specificity 0.662).
There was significant improvement in operative time and total blood loss when comparing group 1 versus group 2 and group 1 versus group 3. The cut-off point for the learning curve was 57 cases when the preset criteria were fulfilled (≤193.3 min operative time and ≤1612.2 mL of total blood loss).Level of Evidence: 4.
回顾性研究。
评估双主治医生策略在严重青少年特发性脊柱侧凸患者中的学习曲线。
双主治医生策略在改善脊柱侧凸手术围手术期结果方面的优势已被报道。然而，这种策略在严重脊柱侧凸中的学习曲线尚未得到广泛研究。
共招募了 105 例 Cobb 角为 90°或更大的青少年特发性脊柱侧凸患者，采用双主治医生策略行后路脊柱融合术。主要结局指标为手术时间、总失血量、异体输血需求、术后住院时间和围手术期并发症。病例按时间顺序分为 1 组：病例 1 至 35 例，2 组：病例 36 至 70 例，3 组：病例 71 至 105 例。选择手术时间（≤193.3 分钟）、总失血量（≤1612.2 毫升）、两者结合和异体输血作为学习曲线的受试者工作特征分析的标准。
平均 Cobb 角为 104.5°±12.3°。1 组（220.6±54.8 分钟；2011.3±881.8 毫升；12 例）与 2 组（183.6±36.7 分钟；1481.6±1035.5 毫升；3 例）和 1 组与 3 组（175.6±38.4 分钟；1343.7±477.8 毫升；3 例）相比，手术时间、总失血量和异体输血需求显著减少（P<0.05）。围手术期并发症 6 例。达到预设标准（平均手术时间和平均总失血量）（曲线下面积 0.740；P<0.001；灵敏度 0.675；特异性 0.662）时，需要 57 例。
与 2 组和 3 组相比，1 组与 2 组和 1 组与 3 组相比，手术时间和总失血量均有显著改善。当达到预设标准（≤193.3 分钟手术时间和≤1612.2 毫升总失血量）时，学习曲线的截止点为 57 例。
4 级。
