脊柱团队在小儿脊柱侧弯手术管理中的益处。

Benefits of a spine team for the surgical management of paediatric scoliosis.

作者信息

Julien-Marsollier Florence, Pardessus Pierre, Brouns Kelly, Happiette Adèle, Dahmani Souhayl, Ilharreborde Brice

机构信息

Université de Paris-Cité, Paris, France; Département d'Anesthésie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France; FHU I2D2, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France.

Université de Paris-Cité, Paris, France; Département d'Anesthésie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France.

出版信息

Orthop Traumatol Surg Res. 2025 May;111(3):103976. doi: 10.1016/j.otsr.2024.103976. Epub 2024 Aug 23.

DOI:10.1016/j.otsr.2024.103976

PMID:39182838

Abstract

BACKGROUND

For many years, blood-saving techniques and the enhanced recovery after surgery approach have been used to optimise the quality of care and shorten hospital stays. The creation of dedicated spine teams combining surgeons and anaesthesiologists specialised in spine surgery has been proven beneficial in adults. The objective of this study was to determine whether involving a spine team in the management of paediatric patients with scoliosis treated by posterior spinal fusion was associated with shorter hospital stays.

HYPOTHESIS

The hospital stay would be shorter in patients managed by a spine team.

MATERIALS AND METHODS

This single-centre, non-randomised, comparative study was initiated after approval by the local ethics committee. One group of patients was managed by a spine team composed of an anaesthesiologist and a surgeon with over 10 years of experience and the control group by an anaesthesiologist and a surgeon with less than 5 years of experience. The primary outcome was hospital stay length (median [interquartile range]).

RESULTS

The study included 157 paediatric patients who underwent spinal fusion in 2021 for adolescent idiopathic scoliosis (AIS, n = 106) or secondary scoliosis (n = 51). The spinal team was involved for 48 (45%) AIS procedures and 38 (74.5%) secondary-scoliosis procedures. Both operative time and anaesthesia time were significantly shorter in the spinal-team group, by 10% and 15% (p < 0.001 for both comparisons), respectively, for SIA and by 20% (p = 0.002) and 25% (p < 0.001), respectively, for secondary scoliosis. The spinal-team group had a shorter median hospital stay, the difference being significant for AIS (in days, 5 [4-7] versus 7.1 [5-10], p = 0.03) and nearly significant for secondary scoliosis (6.9 [5-10] versus 9 [6-23], p = 0.07). Fewer patients required blood transfusion in the spine-team group than in the control group (AIS: 0% versus 8.8%, p = 0.05; and secondary scoliosis, 28% versus 58%, p<0.01).

CONCLUSION

Involvement of a spine team optimises the peri-operative management of patients with AIS, thus shortening the hospital stay. Further work is needed to assess the potential associations of spine team involvement with complication rates.

LEVEL OF EVIDENCE

III; non-randomised comparative study.

摘要

背景

多年来，血液保护技术和术后加速康复方法一直被用于优化医疗质量并缩短住院时间。事实证明，组建由脊柱外科专家和麻醉专家组成的专业脊柱团队对成人患者有益。本研究的目的是确定脊柱团队参与青少年特发性脊柱侧弯后路脊柱融合术治疗的小儿患者管理是否与缩短住院时间相关。

假设

由脊柱团队管理的患者住院时间会更短。

材料与方法

本单中心、非随机对照研究经当地伦理委员会批准后启动。一组患者由一名麻醉医生和一名经验超过10年的外科医生组成的脊柱团队管理，对照组由一名麻醉医生和一名经验少于5年的外科医生管理。主要结局指标为住院时间（中位数[四分位间距]）。

结果

本研究纳入了2021年因青少年特发性脊柱侧弯（AIS，n = 106）或继发性脊柱侧弯（n = 51）接受脊柱融合术的157例小儿患者。脊柱团队参与了48例（45%）AIS手术和38例（74.5%）继发性脊柱侧弯手术。脊柱团队组的手术时间和麻醉时间均显著缩短，AIS患者的手术时间和麻醉时间分别缩短10%和15%（两组比较p均<0.001），继发性脊柱侧弯患者的手术时间和麻醉时间分别缩短20%（p = 0.002）和25%（p<0.001）。脊柱团队组的中位住院时间更短，AIS患者差异有统计学意义（天数，5[4 - 7]对7.1[5 - 10]，p = 0.03），继发性脊柱侧弯患者差异接近有统计学意义（6.9[5 - 10]对9[6 - 23]，p = 0.07）。脊柱团队组需要输血的患者比对照组少（AIS：0%对8.8%，p = 0.05；继发性脊柱侧弯：28%对58%，p<0.01）。