Nakamura Naoyuki, Kawabe Yuichiro, Momose Takako, Oba Masatoshi, Yamamoto Kouji, Takamasu Tetsuya, Suzuki Mayuko, Nakamura Nobuto, Koba Miki
Department of Orthopedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Department of Biostatistics, Yokohama City University, Yokohama, Japan.
Spine Surg Relat Res. 2024 Feb 14;8(4):427-432. doi: 10.22603/ssrr.2023-0193. eCollection 2024 Jul 27.
We aimed to implement the enhanced recovery after surgery (ERAS) protocol for pediatric neuromuscular scoliosis (NMS) surgery and to examine the effectiveness of this program in this study.
Subjects were children with NMS who underwent scoliosis surgery at our department by a surgeon using a single posterior approach. A series of 27 cases before the introduction of ERAS and 27 cases during program stabilization were included in the study. Patient backgrounds did not show significant differences before and after introducing ERAS. Perioperative data, complications, length of hospital stay (LOS), and readmission within 90 days were investigated and statistically analyzed.
When the pre- and post-ERAS induction groups were compared, no significant differences in anesthesia induction time (p=0.979), pelvic fixation (p=0.586), fusion levels (p=0.479), intraoperative hypothermia duration (p=0.154), end-of-surgery body temperature (p=0.197), operative time (p=0.18), postoperative main Cobb angle (p=0.959), main Cobb angle correction rate (p=0.91), postoperative spino-pelvic obliquity (SPO) (p=0.849), and SPO correction rate (p=0.267) were observed. However, significant differences in using V-flap technique (p=0.041), intraoperative blood loss (p=0.001), and LOS (p=0.001) were observed. Intraoperative blood loss was weakly correlated with LOS (p=0.432 and 0.001). No statistically significant difference existed between the V-flap method and LOS (p=0.265). Multiple regression analysis using LOS as the objective variable and ERAS protocols and intraoperative blood loss as explanatory variables revealed that the effect of ERAS on LOS was greater than that of intraoperative blood loss. No statistically significant differences in the readmission rates within 90 days were found.
After the introduction of ERAS, LOS decreased without an increase in complications or readmissions within 90 days.
在本研究中，我们旨在为小儿神经肌肉型脊柱侧凸（NMS）手术实施加速康复外科（ERAS）方案，并检验该方案的有效性。
研究对象为在我科由一名外科医生采用单一后路手术方式进行脊柱侧凸手术的NMS患儿。本研究纳入了引入ERAS之前的27例病例以及方案稳定期的27例病例。引入ERAS前后患者背景无显著差异。对围手术期数据、并发症、住院时间（LOS）以及90天内再入院情况进行调查并进行统计学分析。
比较ERAS引入前后两组时，在麻醉诱导时间（p = 0.979）、骨盆固定（p = 0.586）、融合节段（p = 0.479）、术中体温过低持续时间（p = 0.154）、手术结束时体温（p = 0.197）、手术时间（p = 0.18）、术后主Cobb角（p = 0.959）、主Cobb角矫正率（p = 0.91）、术后脊柱骨盆倾斜度（SPO）（p = 0.849）以及SPO矫正率（p = 0.267）方面未观察到显著差异。然而，在使用V形皮瓣技术（p = 0.041）、术中失血量（p = 0.001）和LOS（p = 0.001）方面观察到显著差异。术中失血量与LOS呈弱相关（p = 0.432和0.001）。V形皮瓣方法与LOS之间无统计学显著差异（p = 0.265）。以LOS为目标变量，以ERAS方案和术中失血量为解释变量进行多元回归分析显示，ERAS对LOS的影响大于术中失血量。90天内再入院率未发现统计学显著差异。
引入ERAS后，LOS缩短，且90天内并发症或再入院情况未增加。
