Ren Bryan O, Mengers Sunita R, Furdock Ryan J, Mistovich R Justin, Belding Jonathan E
Department of Orthopedic Surgery, University of Michigan, Ann Arbor, USA.
Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA.
Cureus. 2024 Dec 15;16(12):e75745. doi: 10.7759/cureus.75745. eCollection 2024 Dec.
Introduction In idiopathic scoliosis surgery, studies have shown two attending surgeons have better curve correction, pain, and recovery time. There is conflicting evidence on operative time, blood loss, infection rate, and hospital length of stay. Limited literature examines the impact of surgeon experience on the dual approach. The purpose of this study was to evaluate the performance of two young orthopedic attendings compared to a senior-level attending in idiopathic scoliosis surgery. Methods We examined adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion by a single or dual-attending approach. We performed a 1:1 propensity score match with the variables of age at surgery, sex, body mass index, Cobb angle, and number of levels fused. Peri- and postoperative outcomes were analyzed. Results There were 24 patients in each cohort. Patients having surgery by dual attendings had a shorter mean operative time overall (232 vs. 327 minutes, p<0.001) and per levels fused (19 vs. 26 minutes per level, p<0.001). Dual attendings had better percent curve correction (70% vs. 56%, p=0.001) and smaller overall final postoperative curve magnitude (17° vs. 25°, p<0.001). Estimated blood loss (421 vs. 989 mL, p=0.023) and cell saver volume transfused (59 vs. 178 mL, p<0.001) were lower in dual attending cases. Dual attending patients had a shorter length of stay (3 vs. 4 days, p<0.001). There were no differences in Hemovac blood loss, transfusion requirements, need for intensive care, or complications. Over time, the young dual attendings improved in hospital length of stay (R: -0.617, p=0.001) and hemovac blood loss (R: -0.474, p=0.019). Conclusion A dual attending approach in idiopathic scoliosis surgery may result in shorter operative time, greater curve correction, reduced operative blood loss, and shortened hospital length of stay. No differences were identified in postoperative blood loss or transfusion requirement, need for intensive care, or overall complication rate. Within the limitations of this study, we conclude that dual attending surgery in idiopathic scoliosis is safe and effective when conducted by two young orthopedic surgeons, with results that are similar to that of a more experienced senior surgeon.
引言 在特发性脊柱侧弯手术中，研究表明两名主刀医生进行手术时，在矫正侧弯、缓解疼痛以及缩短恢复时间方面效果更佳。关于手术时间、失血量、感染率和住院时长，存在相互矛盾的证据。仅有有限的文献探讨了医生经验对双人手术方式的影响。本研究的目的是评估两名年轻骨科主治医生与一名资深主治医生在特发性脊柱侧弯手术中的表现。
方法 我们研究了采用单主刀或双主刀方式进行后路脊柱融合术的青少年特发性脊柱侧弯（AIS）患者。我们根据手术年龄、性别、体重指数、Cobb角和融合节段数等变量进行了1:1倾向评分匹配。分析了围手术期和术后的结果。
结果 每个队列有24例患者。双主刀手术的患者总体平均手术时间更短（232分钟对327分钟，p<0.001），且每个融合节段的手术时间也更短（每节段19分钟对26分钟，p<0.001）。双主刀手术在侧弯矫正百分比方面更佳（70%对56%，p=0.001），术后最终总体侧弯度数更小（17°对25°，p<0.001）。双主刀手术病例的估计失血量（421毫升对989毫升，p=0.023）和术中自体血回输量（59毫升对178毫升，p<0.001）更低。双主刀手术的患者住院时间更短（3天对4天，p<0.001）。在Hemovac引流管失血量、输血需求、重症监护需求或并发症方面没有差异。随着时间推移，年轻的双主刀医生在住院时长（R：-0.617，p=0.001）和Hemovac引流管失血量（R：-0.474，p=0.019）方面有所改善。
结论 特发性脊柱侧弯手术采用双主刀方式可能会缩短手术时间、实现更大程度的侧弯矫正、减少术中失血量并缩短住院时长。在术后失血量或输血需求、重症监护需求或总体并发症发生率方面未发现差异。在本研究的局限性范围内，我们得出结论，由两名年轻骨科医生进行的特发性脊柱侧弯双主刀手术是安全有效的，其结果与经验更丰富的资深医生相似。
