Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
Spine Deform. 2024 Jan;12(1):133-139. doi: 10.1007/s43390-023-00750-6. Epub 2023 Sep 6.
Rapid recovery pathways (RRP) for adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion (PSIF) have been shown to be successful in reducing hospital length of stay (LOS). Although the majority of patients are discharged within 3 days, some patients require longer hospital admission. Previous studies in the United States have identified predictors of prolonged LOS for this patient population. The goal of this project was to determine if these predictors are the same for Canadian scoliosis patients and to identify those features which are different under this single-payer system.
A RRP for scoliosis surgery was implemented in March 2015 at a single, tertiary referral children's hospital in Canada. Previously identified features, along with numerous other patient factors, were collected. Spearman correlations were used to determine the factors most associated with hospital LOS and those factors were used in a multivariable regression model.
A total of 161 patients were included in the analysis. Of the previously identified patient factors, only receiving a peri-operative transfusion was found to be significant (ρ = 0.24; p = 0.002). None of the other pre-identified variables were found to be significantly correlated with LOS. Variables not previously examined that were found to be significantly correlated with hospital LOS included ASA status (ρ = 0.19, p = 0.046), fusion involving both the thoracic and lumbar spine (ρ = 0.18, p = 0.025), and receiving celecoxib on post-operative day 1 (ρ = - 0.16; p = 0.038). The features that had the greatest association with LOS through multivariable regression was receiving a blood transfusion (B = 0.48; 95%CI 0.096-0.89; p = 0.017).
In this study, we found that many of the features found to be significantly correlated with prolonged hospital LOS in the United States are not transferable to the Canadian healthcare system. This is important for the Canadian, and other surgeons in a single-payer system, in order to identify pre-operative or immediate post-operative factors that may extend patient LOS following PSIF and plan resources accordingly.
III; therapeutic.
快速康复路径（RRP）已被证明可成功减少接受后路脊柱内固定融合术（PSIF）的青少年特发性脊柱侧凸患者的住院时间（LOS）。尽管大多数患者在 3 天内出院，但有些患者需要更长时间的住院治疗。美国的先前研究确定了该患者群体 LOS 延长的预测因素。本项目的目的是确定这些预测因素是否适用于加拿大脊柱侧弯患者，并确定在这种单一支付者系统下不同的特征。
2015 年 3 月，在加拿大的一家单一的三级转诊儿童医院实施了脊柱侧凸手术的 RRP。收集了先前确定的特征以及许多其他患者因素。使用 Spearman 相关分析确定与住院 LOS 最相关的因素，并在多变量回归模型中使用这些因素。
共纳入 161 例患者进行分析。在先前确定的患者因素中，只有围手术期输血被发现具有显著意义（ρ=0.24；p=0.002）。没有发现其他先前确定的变量与 LOS 有显著相关性。未被先前检查但与住院 LOS 显著相关的变量包括 ASA 状态（ρ=0.19，p=0.046）、胸腰椎融合（ρ=0.18，p=0.025）和术后第一天接受塞来昔布（ρ=-0.16；p=0.038）。通过多变量回归与 LOS 关联最大的特征是输血（B=0.48；95%CI 0.096-0.89；p=0.017）。
在这项研究中，我们发现，在美国与延长住院 LOS 显著相关的许多特征在加拿大医疗保健系统中不可转移。这对于加拿大和其他在单一支付者系统下的外科医生来说很重要，以便识别可能延长 PSIF 后患者 LOS 的术前或术后即刻因素，并相应地规划资源。
III；治疗性。
