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.
Lorena V Floccari, Bryce Pember, Kenzie D Lundqvist, Matthew B Holloway, Richard P Steiner, Michael T Bigham, Kenneth T Bono, Todd F Ritzman
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引用次数: 0
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.
期刊介绍：
Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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