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Purpose <p>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> Methods <p>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> Results <p>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%, <i>p</i> = 0.039). The post-pathway group had longer mean fusion length (14.4 vs 15.3 levels, <i>p</i> = 0.015), greater frequency of pelvic instrumentation (43.3% vs 73.8%, <i>p</i> = 0.005), and a longer mean operative time (316 vs 357&#xa0;min, <i>p</i> = 0.032). The post-pathway group had a significantly shorter median intensive care unit (ICU) LOS (2.5 vs 2.0 nights, <i>p</i> = 0.017) and a significantly shorter median hospital LOS (7.5 vs 5.0&#xa0;days, <i>p</i> &lt; 0.001). There were no statistically significant differences in early complications.</p> Conclusion <p>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> Level of evidence <p>Level III.</p>

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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

  • 期刊论文

  • 发表日期：

    2025年7月1日

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

摘要

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.