多学科护理路径对需要后路脊柱融合术的高危神经肌肉型脊柱侧弯患者在重症监护病房的住院时间及总住院时间的影响：一项质量改进研究。

The impact of a multi-disciplinary care pathway on intensive care unit and total hospital length of stay in high-risk neuromuscular scoliosis patients who require posterior spinal fusion: a quality improvement study.

作者信息

Floccari Lorena V, Pember Bryce, Lundqvist Kenzie D, Holloway Matthew B, Steiner Richard P, Bigham Michael T, Bono Kenneth T, Ritzman Todd F

机构信息

Department of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery, Akron, OH, 44308, USA.

Northeast Ohio Medical University, Rootstown, OH, USA.

出版信息

Spine Deform. 2025 Jul 1. doi: 10.1007/s43390-025-01112-0.

DOI:10.1007/s43390-025-01112-0

PMID:40593304

Abstract

PURPOSE

The purpose of this study was to establish a multi-disciplinary consensus-based standardized perioperative care pathway for high-risk neuromuscular scoliosis (NMS) patients requiring posterior spinal fusion (PSF) and to compare patient outcomes before and after its implementation.

METHODS

A retrospective comparative cohort study was performed at a freestanding children's hospital in the United States. A multi-disciplinary team reviewed published evidence and developed a consensus-based standardized perioperative pathway that was implemented in May 2018. Pre-pathway (1/2014-4/2018) NMS patients with complex multi-system involvement who underwent PSF were compared to post-pathway (5/2018-12/2023) patients in demographics, radiographic characteristics, surgical variables, disposition, length of stay (LOS), and complications.

RESULTS

Ninety-one patients were included (30 pre-pathway, 61 post-pathway). There were no significant differences in patient demographics or curve characteristics. Central venous catheters were used more often in the pre-pathway group (50.0% vs 27.9%, p = 0.039). The post-pathway group had longer mean fusion length (14.4 vs 15.3 levels, p = 0.015), greater frequency of pelvic instrumentation (43.3% vs 73.8%, p = 0.005), and a longer mean operative time (316 vs 357 min, p = 0.032). The post-pathway group had a significantly shorter median intensive care unit (ICU) LOS (2.5 vs 2.0 nights, p = 0.017) and a significantly shorter median hospital LOS (7.5 vs 5.0 days, p < 0.001). There were no statistically significant differences in early complications.

CONCLUSION

After implementation of a comprehensive multi-disciplinary pathway for high-risk scoliosis patients, patients had a 20% shorter median ICU LOS and a 33% shorter median hospital LOS despite more complex surgeries. Both groups had a similar incidence of early postoperative complications.

LEVEL OF EVIDENCE

Level III.

摘要

目的

本研究旨在为需要后路脊柱融合术（PSF）的高危神经肌肉型脊柱侧凸（NMS）患者建立基于多学科共识的标准化围手术期护理路径，并比较该路径实施前后患者的结局。

方法

在美国一家独立的儿童医院进行了一项回顾性比较队列研究。一个多学科团队回顾了已发表的证据，并制定了基于共识的标准化围手术期路径，该路径于2018年5月实施。将路径实施前（2014年1月至2018年4月）接受PSF的伴有复杂多系统受累的NMS患者与路径实施后（2018年5月至2023年12月）的患者在人口统计学、影像学特征、手术变量、处置方式、住院时间（LOS）和并发症方面进行比较。

结果

共纳入91例患者（路径实施前30例，路径实施后61例）。患者的人口统计学或侧弯特征无显著差异。路径实施前组更常使用中心静脉导管（50.0%对27.9%，p = 0.039）。路径实施后组的平均融合节段更长（14.4节对15.3节，p = 0.015），骨盆内固定的频率更高（43.3%对73.8%，p = 0.005），平均手术时间更长（316分钟对357分钟，p = 0.032）。路径实施后组的重症监护病房（ICU）中位住院时间显著缩短（2.5晚对2.0晚，p = 0.017），医院中位住院时间显著缩短（7.5天对5.0天，p < 0.001）。早期并发症方面无统计学显著差异。