计划性重返手术室对早期特发性脊柱侧凸生长友好型手术治疗结束时健康相关生活质量的影响。
The Impact of Unplanned Return to the Operating Room on Health-related Quality of Life at the End of Growth-friendly Surgical Treatment for Early-onset Scoliosis.
机构信息
Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center.
Department of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital.
出版信息
J Pediatr Orthop. 2022 Jan 1;42(1):17-22. doi: 10.1097/BPO.0000000000002006.
BACKGROUND
Limiting complications, especially unplanned return to the operating room (UPROR), is a major focus in the surgical management of early-onset scoliosis (EOS). Although UPROR remains common in this population, its effect on long-term health-related quality of life (HRQoL) remains unclear. The purpose of this study was to investigate the association between UPROR and end-of-treatment HRQoL in EOS patients treated with growth-friendly instrumentation.
METHODS
Patients with EOS who underwent growth-friendly instrumentation at age less than 10 years from 1993 to 2018, and completed treatment, were identified in a multicenter EOS registry. UPROR events were recorded, and end-of-treatment (defined as skeletal maturity and/or definitive spinal fusion) HRQoL was assessed via the 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24).
RESULTS
A total of 825 patients were identified, and 325 patients (age at surgery: 6.4 y, follow-up: 8.1 y) had end-of-treatment HRQoL data necessary for our investigation. Overall, 129/325 (39.7%) patients experienced 264 UPROR events; the majority (54.2%) were implant-related. Aside from age and etiology, no other variables were determined to be confounders or effect modifiers. Congenital patients with UPROR had worse pain/discomfort by 10.4 points (P=0.057) and worse pulmonary function by 7.8 points (P=0.102) compared with non-UPROR patients adjusting for age. Neuromuscular patients with UPROR had worse pulmonary function by 10.1 points compared with non-UPROR patients adjusting for age (P=0.037). Idiopathic and syndromic patients with UPROR reported consistently worse domain scores than their non-UPROR counterparts, but smaller (<5-point) differences were seen.
CONCLUSIONS
UPROR during growth-friendly surgical treatment for EOS is associated with worse HRQoL in all patients, but particularly in those with neuromuscular or congenital etiologies. Ongoing efforts to avoid UPROR are critical.
LEVEL OF EVIDENCE
Level II. This is a multicenter retrospective cohort study investigating the effect of UPROR on HRQoL (prognostic study).
背景
在早期发病脊柱侧凸（EOS）的外科治疗中，限制并发症尤为重要，尤其是避免计划性再次手术（UPROR）。尽管这种情况在该人群中仍然很常见，但它对长期健康相关生活质量（HRQoL）的影响尚不清楚。本研究的目的是探讨在使用生长友好型器械治疗的 EOS 患者中，UPROR 与治疗结束时 HRQoL 的关系。
方法
从 1993 年至 2018 年，在一个多中心 EOS 登记处确定了在 10 岁以下接受生长友好型器械治疗且完成治疗的 EOS 患者。记录 UPROR 事件，并通过 24 项早期发病脊柱侧凸问卷（EOSQ-24）评估治疗结束时（定义为骨骼成熟和/或确定性脊柱融合）的 HRQoL。
结果
共确定了 825 名患者，其中 325 名患者（手术年龄：6.4 岁，随访：8.1 岁）有治疗结束时 HRQoL 数据，满足我们的研究要求。总体而言，129/325（39.7%）名患者发生了 264 次 UPROR 事件；其中大多数（54.2%）与植入物有关。除了年龄和病因外，没有其他变量被确定为混杂因素或效应修饰剂。调整年龄后，有 UPROR 的先天性患者疼痛/不适评分差 10.4 分（P=0.057），肺功能差 7.8 分（P=0.102）；调整年龄后，有 UPROR 的神经肌肉患者肺功能差 10.1 分（P=0.037）。有 UPROR 的特发性和综合征性患者报告的各领域评分均比无 UPROR 的患者差，但差异较小（<5 分）。
结论
在使用生长友好型器械治疗 EOS 期间发生 UPROR 与所有患者的 HRQoL 较差相关，但在神经肌肉或先天性病因的患者中更为明显。目前正在努力避免 UPROR，这一点至关重要。
证据等级
II 级。这是一项多中心回顾性队列研究，旨在探讨 UPROR 对 HRQoL 的影响（预后研究）。
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