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A dedicated spine team is more efficient and improves perioperative outcomes in idiopathic scoliosis surgery: a
Sin Ying Lee1, Masayoshi Iwamae2, Chee Kidd Chiu1
1Department of Orthopedic Surgery, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
Background Context:
Operating theatre (OT) inefficiency often leads to unnecessary healthcare expenditure. A dedicated spine team (DST) approach may enhance OT efficiency in scoliosis surgeries. However, its adoption remains debatable, as some believe it may require significant investment in training and expertise, pose potential administrative challenges, and question whether the perceived impact on perioperative outcomes justifies these efforts.
Purpose:
This study aimed to evaluate the OT efficiency and perioperative outcomes of the DST approach compared with the nondedicated spine team (NDST) approach.
Study Design:
Retrospective study.
Patient Sample:
This study initially identified 235 patients with idiopathic scoliosis (IS) who underwent posterior spinal fusion (PSF) using either the DST or NDST approach between 2022 and 2024. Patients were divided into 2 groups: DST (180 cases) and NDST (55 cases). Following propensity score matching (PSM), 74 patients were included in the final analysis, with 37 cases matched to each group.
Outcome Measures:
Primary outcomes included OT efficiency (represented by preoperative time, operative time, postoperative time, and total OT time), total blood loss and salvaged blood volume, perioperative complications, postoperative major Cobb angle, hemoglobin (Hb) level, blood transfusion requirement, postoperative patient-controlled analgesia (PCA) morphine usage, and length of hospital stay. Operative time was subdivided into 4 stages (Stage 1: exposure, Stage 2: screw insertion, Stage 3: correction and balancing, and Stage 4: corticotomies, bone grafting, and closure).
Methods:
The DST comprised 3 senior spine consultants who operated using a dual attending surgeon strategy, supported by a dedicated anesthetic consultant, and a consistent OT team, including orthopedic scrub nurses, anesthetic nurses, radiographers, and neuromonitoring technicians. The NDST comprised 1 attending surgeon (from the DST), 1 spine surgery fellow as the second surgeon, as well as anesthetic and OT staff assigned according to the OT roster. The intraoperative team size was identical between the 2 groups. PSM was performed using nearest-neighbor matching with a match tolerance of 0.05. Multiple linear regression analysis was performed to identify factors influencing the outcomes.
Results:
Following PSM, 37 cases were included in each group. There were significant differences between the DST and NDST in preoperative time (38.1±4.5 minutes vs 75.1±19.1 minutes), operative time (138.5±35.1 minutes vs 206.2±44.4 minutes), and postoperative time (13.8±4.4 minutes vs 35.0±25.8 minutes) (p<.001). The DST had significantly shorter duration in Stage 1 (exposure), Stage 2 (screw insertion), and Stage 4 (corticotomies, bone grafting, and closure) as compared to the NDST (p<.001). The DST had significantly lesser total blood loss (p=.029) and postoperative PCA morphine usage (p<.001) than the NDST. Multiple linear regression analysis revealed that the DST approach was significantly associated with shorter operative time (β=-0.53, p<.001) and lower postoperative PCA morphine usage (β=-0.52, p=.016). Total blood loss was independently associated with operative time (β=0.63, p<.001).
Conclusion:
The DST approach in PSF was significantly associated with shorter operative time and, as a secondary outcome, reduced postoperative PCA morphine usage. Total blood loss was independently associated with operative time.
