Mapping the Road to Recovery: Shorter Stays and Satisfied Patients in Posterior Spinal Fusion
| Autor: | Rameshwar R. Rao, Robert N. Hensinger, Michelle S. Caird, Maryann Hayes, Frances A. Farley, Ying Li, Cathy Lewis |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Scoliosis Sitting 03 medical and health sciences 0302 clinical medicine Patient satisfaction Post-hoc analysis medicine Humans Pain Management Orthopedics and Sports Medicine Patient Reported Outcome Measures Postoperative Period Retrospective Studies 030222 orthopedics Foley business.industry Retrospective cohort study General Medicine Length of Stay medicine.disease Surgery Spinal Fusion Treatment Outcome Patient Satisfaction Spinal fusion Pediatrics Perinatology and Child Health Female Analysis of variance business 030217 neurology & neurosurgery |
| Zdroj: | Journal of pediatric orthopedics. 37(8) |
| ISSN: | 1539-2570 |
| Popis: | Adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) experience variations in their hospital care, which may lead to differences in objective and patient-reported outcomes. The purpose of this study was to demonstrate that using plan of care—educating families preoperatively and standardizing some aspects of care—would decrease time to mobility and time to discharge while maintaining pain control and patient satisfaction. Chart review was conducted in 3 groups—preprotocol (December 2008 to December 2009, n=51), first protocol (December 2, 2009 to July 24, 2013, n=100), and second protocol (July 25, 2013 to June 1, 2014, n=39)—to track pain scores (0 to 10), time to regular diet, Foley catheter removal, epidural catheter removal, mobility, and discharge. Patient satisfaction surveys (0 to 10) were administered before discharge. Statistical analysis was performed using a 1-way analysis of variance test with Tukey post hoc analysis. Average pain scores were similar in all groups. Time to sitting was significantly reduced in both first protocol (27.2±9.8 h, P=1×10−8) and second protocol (28.4±13.6 h, P=3×10−5) compared with preprotocol (40.2±15.4 h). Time to discharge was significantly lower in second protocol (84.3±27.2 h, P=0.036) compared with first protocol (98.4±27.8 h). Patient satisfaction with care was significantly higher in first protocol (9.1/10, P=2×10−6) and second protocol (8.6/10, P=5×10−4) compared with preprotocol (6.5/10). By educating families preoperatively and standardizing portions of postoperative care in PSF for AIS, pain scores were significantly reduced while overall satisfaction remained high. Specifically, by removing the epidural and Foley catheters on postoperative day 2, time to discharge was dramatically decreased by 15 hours. The application of a multidisciplinary, evidence-driven plan of care for AIS patients undergoing PSF improves throughput and has beneficial effects on objective and patient-reported outcomes. Level III—retrospective case series. |
| Databáze: | OpenAIRE |
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