A study presented at the annual meeting of the Scoliosis Research Society (SRS; 5-8 September 2012, Chicago, USA) indicates that patients who receive care on a general ward after undergoing spinal fusion surgery may have better outcomes than patients who receive care in an intensive care unit (ICU).
Traditionally, patients who receive spinal fusion surgery are postoperatively managed in an ICU as many institutions believe ICU management is necessary when major surgery, such as fusion surgery, is involved. However, in their study, David Skaggs, Children’s Orthopedic Center, Children’s Hospital Los Angeles, Los Angeles, USA, and others reported that in the USA there is a focus on reducing healthcare costs while providing better quality healthcare and improving patient satisfaction. They reported: “We hypothesised that healthy patients after spinal fusion for adolescent idiopathic scoliosis can safely be managed on a general surgical floor postoperatively, instead of an ICU, and thereby, also reduce the costs of hospitalisation.”
In the retrospective review of 124 patients, 66 were managed in an ICU and 58 were managed on a general ward. Skaggs et al found that patients in the general ward group received significantly less analgesic and anti-anxiety medications than patients in the ICU. Patient in the general ward group also had significantly fewer postoperative blood tests, fewer days in hospital, and fewer physical therapy sessions compared with the intensive care unit group. The investigators reported: “No patient from the floor group had to be admitted to the ICU. Average charges for the floor group was $33,120.70 [€25,929.82] and for the intensive care unit group was $39,252.26 [€30,731.51]”.
Skaggs told Spinal News International that one potential reason as to why patients in the general ward did better than patients in the ICU was that transfer from an ICU to a general ward can be problematic in terms of patient discomfort and loss of continuity of care (eg, drain output). He said: “Also, in the ICU there are many sicker patients who may require more time and attention of the nursing staff [than fusion patients]; on the floor, the postoperative spinal patients are likely to receive proportionally more time and attention.”
Skaggs added that there would still be some patients who should be managed in an ICU rather than a general ward. He explained these included: “Patients who require increased blood pressure to maintain spinal cord perfusion because of loss of neuromonitoring signals intraoperatively or other reasons for particular concern for neurologic deficit in the postoperative period. Also, there are patients with cardiac or pulmonary problems, patients with massive blood loss and fluid shifts, and intubated patients, etc.”