Bada E, Gouda J, Sewell M D, Jones M, McKay G, Canchi-Murali N, Spilsbury J B, Marks D S, Gardner A, Mehta J S
Paediatric Spinal Deformity Unit, The Royal Orthopaedic Hospital, Birmingham, UK.
Paediatric Anaesthesia, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
Spine Deform. 2025 Mar;13(2):603-610. doi: 10.1007/s43390-024-00992-y. Epub 2024 Oct 27.
Children undergoing either posterior spinal fusion (PSF) or index insertion of growing rods for neuromuscular or genetic/syndromic scoliosis may require post-operative care on the paediatric intensive care unit (PICU). Demands on this limited resource result in frequent bed shortage related cancellations. In response, an ad-hoc or 'pop-up' ward-based high-dependency unit (POPUP-HDU) was developed. This converts a ward bed to POP-HDU bed for the required time. This study assesses the safety and efficacy of postoperative management that utilises POPUP-HDU as an alternative to a PICU bed.
Retrospective review of 111 consecutive children undergoing posterior surgery for scoliosis between June 2016 and April 2023. The inclusion criteria included a diagnosis of genetic/syndromic or neuromuscular scoliosis; PSF or primary insertion of distraction-based growth rods and requirement for postoperative care in a PICU. We excluded those children that were mandated to go to PICU post-operatively for any reason by the anaesthetic team.
49 patients (mean age 13.0 years) were managed on PICU, and 62 (mean age 11.4 years) on POPUP-HDU. The groups were matched with respect to body weight, curve magnitude, operative duration, type of fusion procedure performed, the presence of cardiac malformations, the use of home breathing support, the number of operated levels, pelvic instrumentation and intraoperative blood loss. 8 patients in the PICU, and 16 in the POP-HDU groups were readmitted back to PICU following step-down to the hospital ward (p = 0.27). The median PICU length of stay was 1 day in the PICU group and less than a day in POPUP-HDU (for those that needed to be subsequently admitted to PICU). The median total length of hospital stay was 10 days in the PICU group, and 8 days in POPUP-HDU (p < 0.05). 14 patients developed medical complications in the PICU group, compared to 19 in POPUP-HDU. There were no bedshortage cancellations in POPUP-HDU, compared to 23 in PICU.
For children with neuromuscular, genetic or syndromic scoliosis undergoing PSF or growth rods that are not deemed suitable for immediate ward-level post-operative care, POPUP-HDU provided a safe alternative to PICU for appropriate patients and was associated with shorter hospital stay and fewer cancellations for lack of PICU beds.
Therapeutic Level III.
接受后路脊柱融合术（PSF）或初次植入生长棒治疗神经肌肉型或遗传/综合征型脊柱侧弯的儿童，术后可能需要在儿科重症监护病房（PICU）接受护理。对这一有限资源的需求导致因床位短缺而频繁取消手术。作为应对措施，设立了一个临时的或“弹出式”的病房高依赖单元（POPUP-HDU）。它可在需要的时间段内将病房床位转换为POP-HDU床位。本研究评估了利用POPUP-HDU替代PICU床位进行术后管理的安全性和有效性。
回顾性分析2016年6月至2023年4月期间连续接受脊柱侧弯后路手术的111例儿童。纳入标准包括诊断为遗传/综合征型或神经肌肉型脊柱侧弯；PSF或初次植入基于撑开的生长棒，且术后需要在PICU接受护理。我们排除了因任何原因被麻醉团队要求术后必须入住PICU的儿童。
49例患者（平均年龄13.0岁）在PICU接受治疗，62例（平均年龄11.4岁）在POPUP-HDU接受治疗。两组在体重、侧弯程度、手术时长、所施行的融合手术类型、心脏畸形的存在情况、家庭呼吸支持的使用情况、手术节段数量、骨盆器械固定以及术中失血量方面相匹配。从PICU转至医院病房后，PICU组有8例患者再次入住PICU，POP-HDU组有16例（p = 0.27）。PICU组在PICU的中位住院时长为1天，POPUP-HDU组（对于那些随后需要入住PICU的患者）少于1天。PICU组的中位总住院时长为10天，POPUP-HDU组为8天（p < 0.05）。PICU组有14例患者出现医疗并发症，POPUP-HDU组有19例。POPUP-HDU没有因床位短缺而取消手术的情况，PICU有23例。
对于接受PSF或生长棒治疗的神经肌肉型、遗传型或综合征型脊柱侧弯儿童，如果不适合术后立即在病房护理，POPUP-HDU为合适的患者提供了一种安全的替代PICU的选择，且与缩短住院时间以及减少因PICU床位不足而取消手术的情况相关。
治疗性III级。
