Elevated hospital floor-based HDU (POPUP-HDU): a new safe alternative to PICU for high-risk neuromuscular and syndromic children undergoing scoliosis surgery.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2024-10-27 DOI:10.1007/s43390-024-00992-y
E Bada, J Gouda, M D Sewell, M Jones, G McKay, N Canchi-Murali, J B Spilsbury, D S Marks, A Gardner, J S Mehta
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引用次数: 0

Abstract

Purpose: Children undergoing either posterior spinal fusion (PSF) or index insertion of growing rods for neuromuscular or genetic/syndromic scoliosis may require post-operative care on the paediatric intensive care unit (PICU). Demands on this limited resource result in frequent bed shortage related cancellations. In response, an ad-hoc or 'pop-up' ward-based high-dependency unit (POPUP-HDU) was developed. This converts a ward bed to POP-HDU bed for the required time. This study assesses the safety and efficacy of postoperative management that utilises POPUP-HDU as an alternative to a PICU bed.

Methods: Retrospective review of 111 consecutive children undergoing posterior surgery for scoliosis between June 2016 and April 2023. The inclusion criteria included a diagnosis of genetic/syndromic or neuromuscular scoliosis; PSF or primary insertion of distraction-based growth rods and requirement for postoperative care in a PICU. We excluded those children that were mandated to go to PICU post-operatively for any reason by the anaesthetic team.

Results: 49 patients (mean age 13.0 years) were managed on PICU, and 62 (mean age 11.4 years) on POPUP-HDU. The groups were matched with respect to body weight, curve magnitude, operative duration, type of fusion procedure performed, the presence of cardiac malformations, the use of home breathing support, the number of operated levels, pelvic instrumentation and intraoperative blood loss. 8 patients in the PICU, and 16 in the POP-HDU groups were readmitted back to PICU following step-down to the hospital ward (p = 0.27). The median PICU length of stay was 1 day in the PICU group and less than a day in POPUP-HDU (for those that needed to be subsequently admitted to PICU). The median total length of hospital stay was 10 days in the PICU group, and 8 days in POPUP-HDU (p < 0.05). 14 patients developed medical complications in the PICU group, compared to 19 in POPUP-HDU. There were no bedshortage cancellations in POPUP-HDU, compared to 23 in PICU.

Conclusions: For children with neuromuscular, genetic or syndromic scoliosis undergoing PSF or growth rods that are not deemed suitable for immediate ward-level post-operative care, POPUP-HDU provided a safe alternative to PICU for appropriate patients and was associated with shorter hospital stay and fewer cancellations for lack of PICU beds.

Level of evidence: Therapeutic Level III.

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医院地面高架加护病房(POPUP-HDU):为接受脊柱侧弯手术的高风险神经肌肉和综合征患儿提供了一种替代 PICU 的新的安全方式。
目的:因神经肌肉或遗传/综合症脊柱侧凸而接受后路脊柱融合术(PSF)或植入生长棒的儿童可能需要在儿科重症监护病房(PICU)接受术后护理。对这一有限资源的需求导致经常出现因床位短缺而取消手术的情况。为此,我们开发了一种基于病房的临时或 "弹出式 "高依赖性病房(POPUP-HDU)。它能在所需时间内将病房床位转换为 POP-HDU 床位。本研究评估了利用 POPUP-HDU 代替 PICU 病床进行术后管理的安全性和有效性:方法:回顾性分析2016年6月至2023年4月期间连续接受脊柱侧弯后路手术的111名儿童。纳入标准包括:遗传/综合症或神经肌肉性脊柱侧凸诊断;PSF或牵引式生长棒的初次插入,以及需要在PICU进行术后护理。我们排除了那些因任何原因被麻醉团队强制要求术后进入PICU的儿童:49 名患者(平均年龄 13.0 岁)在 PICU 接受治疗,62 名患者(平均年龄 11.4 岁)在 POPUP-HDU 接受治疗。两组患者在体重、曲线幅度、手术时间、融合术类型、是否存在心脏畸形、是否使用家庭呼吸支持、手术层面数、骨盆器械和术中失血量等方面均相匹配。PICU组和POP-HDU组分别有8名和16名患者在下到医院病房后再次被送回PICU(P = 0.27)。PICU 组患者的 PICU 中位住院时间为 1 天,而 POPUP-HDU 组患者的 PICU 中位住院时间不到 1 天(对于那些随后需要入住 PICU 的患者)。PICU 组的总住院时间中位数为 10 天,POPUP-HDU 组为 8 天(P 结论:POPUP-HDU 组的总住院时间中位数为 10 天,POPUP-HDU 组为 8 天):对于接受 PSF 或生长棒手术的神经肌肉型、遗传型或综合型脊柱侧凸患儿,如果不适合立即接受病房级术后护理,POPUP-HDU 可为合适的患者提供 PICU 以外的安全替代方案,而且住院时间更短,因缺乏 PICU 床位而取消手术的情况更少:证据等级:治疗 III 级。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
期刊最新文献
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