Lorena V Floccari, Bryce Pember, Kenzie D Lundqvist, Matthew B Holloway, Richard P Steiner, Michael T Bigham, Kenneth T Bono, Todd F Ritzman
{"title":"多学科护理路径对需要后路脊柱融合术的高危神经肌肉性脊柱侧凸患者重症监护病房和总住院时间的影响：一项质量改善研究","authors":"Lorena V Floccari, Bryce Pember, Kenzie D Lundqvist, Matthew B Holloway, Richard P Steiner, Michael T Bigham, Kenneth T Bono, Todd F Ritzman","doi":"10.1007/s43390-025-01112-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":"1529-1537"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Lorena V Floccari, Bryce Pember, Kenzie D Lundqvist, Matthew B Holloway, Richard P Steiner, Michael T Bigham, Kenneth T Bono, Todd F Ritzman\",\"doi\":\"10.1007/s43390-025-01112-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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. 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引用次数: 0
摘要
目的：本研究的目的是为需要后路脊柱融合术（PSF）的高危神经肌肉性脊柱侧凸（NMS）患者建立基于多学科共识的标准化围手术期护理路径，并比较其实施前后患者的预后。方法：在美国一家独立儿童医院进行回顾性比较队列研究。一个多学科团队审查了已发表的证据，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。将通路前（2014年1月- 2018年4月）与通路后（2018年5月- 2023年12月）患者在人口统计学、放射学特征、手术变量、性格、住院时间（LOS）和并发症方面进行比较。结果：纳入91例患者（通路前30例，通路后61例）。两组患者人口统计学和曲线特征无显著差异。通路前组中心静脉导管的使用频率更高（50.0% vs 27.9%, p = 0.039）。通路后组的平均融合长度更长（14.4比15.3节段，p = 0.015），骨盆内固定频率更高（43.3%比73.8%,p = 0.005），平均手术时间更长（316比357分钟，p = 0.032）。术后路径组重症监护病房（ICU） LOS的中位数显著缩短（2.5 vs 2.0晚，p = 0.017），住院LOS的中位数显著缩短（7.5 vs 5.0天，p）。结论：在对高风险脊柱侧凸患者实施综合多学科路径后，患者的ICU LOS中位数缩短20%，住院LOS中位数缩短33%，尽管手术更加复杂。两组术后早期并发症发生率相似。证据等级：三级。
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.
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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