The association between implementation of a coordinated care pathway in idiopathic scoliosis patients and a reduction in perioperative outcome disparities

2021 ◽  
Author(s):  
P Dela Merced ◽  
C Vazquez Colon ◽  
A Mirzada ◽  
A Oke ◽  
Z Gal ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Care Pathway ◽  
Coordinated Care ◽  
Perioperative Outcome

scholarly journals Perioperative outcome of severe rigid idiopathic scoliosis: Single-staged posterior spinal fusion utilizing a dual attending surgeon strategy. A report of 41 patients

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902093600
Author(s):  
Chris Yin Wei Chan ◽  
Weng Hong Chung ◽  
Yuki Mihara ◽  
Sin Ying Lee ◽  
Pei Ying Ch’ng ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Hospital Stay ◽  
Cobb Angle ◽  
Perioperative Complications ◽  
Postoperative Hospital Stay ◽  
Transfusion Rate ◽  
Perioperative Outcome ◽  
Correction Rate ◽  
Operation Duration ◽  
The Mean

Purpose: Various surgical strategies including combined approach and spinal osteotomies in severe rigid scoliosis had been reported with significant perioperative complication rates. The use of single-staged posterior spinal fusion (PSF) utilizing a dual attending surgeon strategy for severe rigid scoliosis has not been widely reported. Methods: This was a retrospective study aimed to evaluate the perioperative outcome of single-staged PSF in severe rigid idiopathic scoliosis patients (Cobb angle ≥90° and ≤30% flexibility). Forty-one patients with severe rigid idiopathic scoliosis who underwent single-staged PSF were included. The perioperative outcome parameters were operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, transfusion rate, patient-controlled anesthesia morphine usage, length of postoperative hospital stay, and perioperative complications. Radiological parameters included preoperative and postoperative Cobb angle, correction rate, side-bending flexibility, and side-bending correction index. Results: The mean age was 16.9 ± 5.6 years. The mean preoperative Cobb angle was 110.8 ± 12.1° with mean flexibility of 23.1 ± 6.3%. The mean operation duration was 215.5 ± 45.2 min with mean blood loss of 1752.6 ± 830.5 mL. The allogeneic blood transfusion rate was 24.4%. The mean postoperative hospital stay was 76.9 ± 26.7 h. The mean postoperative Cobb angle and correction rate were 54.4 ± 12.8° and 50.9 ± 10.1%, respectively. The readmission rate in this cohort was 2.4%. Four perioperative complications were documented (9.8%), one somatosensory evoke potential signal loss, one superficial infection, one lung collapse, and one superior mesenteric artery syndrome. Conclusions: Severe rigid idiopathic scoliosis treated with single-staged PSF utilizing a dual attending surgeon strategy demonstrated an average correction rate of 50.9%, operation duration of 215.5 min, and postoperative hospital stay of 76.9 h with a 9.8% perioperative complication rate.

Hereditary haemorrhagic telangiectasia: development of a regional life-course collaborative clinical care pathway

2021 ◽  
pp. 1-9
Author(s):  
Emily Anderson ◽  
Richard Green ◽  
Andrew Swift ◽  
Malcolm G Semple
Keyword(s):  
Best Practice ◽  
Care Pathway ◽  
Genetic Disorder ◽  
Clinical Care ◽  
Quality Care ◽  
Reference Network ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Coordinated Care ◽  
Multiple Organs ◽  
European Reference Network

Hereditary haemorrhagic telangiectasia is a rare, genetic disorder that can present at any age. It is characterised by epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations, which can affect multiple organs. Early diagnosis and management reduces the morbidity and mortality associated with the disease. There is a well-established hereditary haemorrhagic telangiectasia clinic in London, and excellent links across Europe via the European Reference Network. However, local coordinated care for patients with hereditary haemorrhagic telangiectasia across the UK can be variable and often absent for children and young people. Some patients travel long distances to receive care in London, while others are referred to local clinicians or lost to follow up entirely. This article presents the experience to date from two regional UK centres (Liverpool and Dundee) where care for patients with hereditary haemorrhagic telangiectasia is being coordinated and streamlined. While there is still a lot to learn, this article highlights some of the successes and challenges identified so far, with suggestions for how these could be addressed. Collaborative regional networks such as these can facilitate the sharing of best practice and ensure that all patients with hereditary haemorrhagic telangiectasia are able to access safe, high-quality care.

Perioperative Outcome of Severe Idiopathic Scoliosis (Cobb Angle ≥ 90°)

Spine ◽  
2020 ◽  
Vol 45 (6) ◽  
pp. 381-389
Author(s):  
Yuki Mihara ◽  
Weng Hong Chung ◽  
Chee Kidd Chiu ◽  
Mohd Shahnaz Hasan ◽  
Sin Ying Lee ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Perioperative Outcome

Perioperative Outcome of Single Stage Posterior Spinal Fusion for Severe Adolescent Idiopathic Scoliosis (AIS) (Cobb Angle ≥90°)

Spine ◽  
2019 ◽  
Vol 44 (6) ◽  
pp. E348-E356 ◽  
Author(s):  
Mun Keong Kwan ◽  
Chee Kidd Chiu ◽  
Mohd Shahnaz Hasan ◽  
Shun Herng Tan ◽  
Ling Hui Loh ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Single Stage ◽  
Perioperative Outcome

scholarly journals A Comparison Between the Perioperative Outcomes of Female Adolescent Idiopathic Scoliosis (AIS) Versus Adult Idiopathic Scoliosis (AdIS) Following Posterior Spinal Fusion: A Propensity Score Matching Analysis Involving 425 Patients

2021 ◽  
pp. 219256822199151
Author(s):  
Chris Yin Wei Chan ◽  
Siti Mariam Abd Gani ◽  
Weng Hong Chung ◽  
Chee Kidd Chiu ◽  
Mohd Shahnaz Hasan ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Posterior Spinal Fusion ◽  
Perioperative Outcomes ◽  
Perioperative Outcome ◽  
Correction Rate ◽  
Operation Duration

Study Design: Retrospective propensity score matching (PSM) study. Objective: To investigate the perioperative outcomes comparing adolescent idiopathic scoliosis (AIS) and adult idiopathic scoliosis (AdIS) patients following posterior spinal fusion (PSF). Methods: 425 female AIS and AdIS patients who were operated (between January 2015 to March 2020) using a dual attending surgeon strategy were stratified into G1 (AIS aged 10-16 years old) and G2 (AdIS > 20 years old). PSM analysis with one-to-one, nearest neighbor matching technique with match tolerance of 0.001 was used to matched 357 AIS patients to 68 AdIS patients. Operation duration, intraoperative blood loss (IBL), blood loss percentage, hemoglobin drift, blood salvaged, postoperative wound length, allogenic blood transfusion requirement, postoperative hospital stay, postoperative Cobb, correction rate and postoperative complications were documented and reported. Results: Following PSM, G1 and G2 each had 50 patients with comparable and balanced covariates. As anticipated, G2 patients were heavier, taller and had higher body mass index compared to G1 patients ( P < 0.05). We could not find any significant differences in the perioperative outcome comparing this 2 groups. AIS and AdIS patients had similar operation duration (125.9 ± 27.2 min vs 127.3 ± 37.8 min), IBL (749.8 ± 315.7 ml vs 723.8 ± 342.1 ml) and length of hospital stay (3.3 ± 0.4 days vs 3.5 ± 0.8 days) ( P > 0.05). Hemoglobin drift and amount of blood salvaged were comparable ( P > 0.05). G2 had stiffer curves. There was a trend toward a lower correction rate in G2 in the immediate postoperative period, however it did not reach statistical significance (61.8 ± 11.2% vs. 66.3 ± 11.6%, P = 0.051). No patients required blood transfusion and none had any postoperative complications. Conclusion: Adolescent and adult female scoliosis patients had comparable perioperative outcome following PSF surgery that was carried out using a dual attending surgeon strategy.

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