Floccari Lorena V, Pember Bryce, Lundqvist Kenzie D, Holloway Matthew B, Steiner Richard P, Bigham Michael T, Bono Kenneth T, Ritzman Todd F
Department of Orthopedic Surgery, Akron Children's Hospital, 215 W Bowery, Akron, OH, 44308, USA.
Northeast Ohio Medical University, Rootstown, OH, USA.
Spine Deform. 2025 Jul 1. doi: 10.1007/s43390-025-01112-0.
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.
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.
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.
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 III.
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。
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。
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。
在为高危脊柱侧凸患者实施全面的多学科路径后，尽管手术更为复杂，但患者的ICU中位住院时间缩短了20%，医院中位住院时间缩短了33%。两组术后早期并发症的发生率相似。
三级。
