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

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.