Sarwahi Vishal, Hasan Sayyida, Rao Himanshu, Visahan Keshin, Grunfeld Matan, Dzaugis Peter, Wendolowski Stephen, Vora Rushabh, Galina Jesse, Lo Yungtai, Moguilevitch Marina, Thornhill Beverly, Amaral Terry, DiMauro Jon-Paul
Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen Children's Medical Center, Northwell Hofstra School of Medicine, 7 Vermont Drive, Lake Success, New Hyde Park, NY, 11042, USA.
New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
Spine Deform. 2023 Nov;11(6):1409-1418. doi: 10.1007/s43390-023-00728-4. Epub 2023 Jul 28.
The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions.
A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal-Wallis, and χ tests were used.
500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing.
Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.
本研究的目的是确定标准化是否能改善青少年特发性脊柱侧凸（AIS）手术的结果，以及它是否可以在不同机构之间转换。
对2009年至2021年期间在两个机构（IA和IB）接受手术的AIS患者进行回顾性研究。每个机构都包括一个非标准化（NST）组和一个标准化组（ST）。2015年，外科医生更换了机构（从IA到IB）。确定了不同机构之间的可重复性。使用中位数和四分位间距（IQR）、Kruskal-Wallis检验和χ检验。
纳入了500例连续的AIS患者。各机构之间的年龄（p = 0.06）、体重指数（p = 0.74）、术前Cobb角（p = 0.53）和融合节段数（p = 0.94）相似。IA-ST组和IB-ST组的失血量较少（p < 0.001），手术时间较短（p < 0.001）。IB-ST组的住院时间明显较短（p < 0.001），输血率较低（p = 0.007），优于IB-NST组。IB-ST组的标准化方案使成本降低了18.7%，显著降低了住院成本，从IB-NST组的74794.05美元降至IB-ST组的60778.60美元（p < 0.001）。对手术时间的年度分析显示，虽然标准化方案的实施减少了IA机构内的手术时间，但当外科医生转到IB机构并实现标准化后，IB机构的手术时间值再次下降，并持续逐年下降。在IB机构中，标准化方案增加的内容在稳定之前暂时影响了手术时间。
由外科医生主导的标准化AIS方法和简化的手术步骤可改善手术结果和效率，可在不同机构之间转换，并能适应额外的方案变化。
