Abstract
Study design
Retrospective comparative study.
Objective
To determine how the use of dedicated spine surgical nurses and scrub technicians impacted surgical outcomes of posterior spinal fusions for adolescent idiopathic scoliosis (AIS).
Summary of background data
Dedicated team approaches to surgery have been shown to improve surgical outcomes. However, their study on orthopaedics and spine surgery is limited.
Methods
A retrospective review of all patients who underwent a primary posterior spinal fusion of seven or more levels for AIS at a tertiary care pediatric hospital with a minimum of 2 years of follow-up from 2006 to 2013 was conducted. Our institution had dedicated spine surgeons and anesthesiologists throughout the study period, but use of dedicated spine nurses and scrub technicians was variable. The relationship between the proportion of nurses and scrub technicians that were dedicated spine and surgical outcome variables was examined. A multiple regression was performed to control for the surgeon performing the case and the start time.
Results
A total of 146 patients met criteria. When teams were composed of < 60% dedicated spine nurses and scrub technicians, there was 34 min more total OR time (p = .008), 27 min more surgical time (p = .037), 7 min more nonsurgical OR time (p = .030), 30% more estimated blood loss (EBL) (p = .013), 27% more EBL per level instrumented (p = .020), 113% more allogeneic transfusion (p = .006), and 104% more allogeneic transfusion per level instrumented (p = .009). There was no significant difference in length of stay, unplanned staged procedures, surgical site infection, reoperation, or major medical complications.
Conclusions
Performing posterior spinal fusions for AIS patients with dedicated spine nurses and scrub technicians is associated with a significant decrease in total OR time, blood loss, and transfusion rates.
Level of evidence
III.
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RRM (none), LMA (personal fees from Biomet, Zimmer, Medtronic, and NuVasive; other from Eli Lilly, other from the Journal of Pediatric Orthopedics, personal fees from Orthobullets, other from Pediatric Orthopaedic Society of North America; Scoliosis Research Society, outside the submitted work), EN (none), GS (other from Pfizer, outside the submitted work), HG (none), DLS (CHLA Foundation: Board or committee member, Grand Rounds: Paid consultant, Green Sun Medical: Stock or stock Options, Growing Spine Foundation: Board or committee member, Growing Spine Study Group: Board or committee member, Journal of Children's Orthopaedics: Editorial or governing board, Medtronic: Other financial or material support, Nuvasive (Co-PI, Paid to Growing Spine Foundation): Research support, Orthobullets: Editorial or governing board; Paid consultant; Stock or stock Options, Orthopedics Today: Editorial or governing board, Spine Deformity: Editorial or governing board, Wolters Kluwer Health: Publishing royalties, financial or material support, ZimmerBiomet: IP royalties; Other financial or material support; Paid consultant; Paid presenter or speaker, Zipline Medical, Inc.: Stock or stock Options).
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This study has been carried out with approval from the Committee on Clinical Investigations at Children’s Hospital Los Angeles.
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Murgai, R.R., Andras, L.M., Nielsen, E. et al. Dedicated spine nurses and scrub technicians improve intraoperative efficiency of surgery for adolescent idiopathic scoliosis. Spine Deform 8, 171–176 (2020). https://doi.org/10.1007/s43390-020-00037-0
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DOI: https://doi.org/10.1007/s43390-020-00037-0