Complications in the Surgical Treatment of 19,360 Cases of Pediatric Scoliosis A Review of the Scoliosis Research Society Morbidity and Mortality Database
ABSTRACT Retrospective review of a multicenter database.
To determine the complication rates associated with surgical treatment of pediatric scoliosis and to assess variables associated with increased complication rates.
Wide variability is reported for complications associated with the operative treatment of pediatric scoliosis. Limited number of patients, surgeons, and diagnoses occur in most reports. The Scoliosis Research Society Morbidity and Mortality (M&M) database aggregates deidentified data, permitting determination of complication rates from large numbers of patients and surgeons.
Cases of pediatric scoliosis (age ≤18 years), entered into the Scoliosis Research Society M&M database between 2004 and 2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed.
A total of 19,360 cases fulfilled inclusion criteria. Of these, complications occurred in 1971 (10.2%) cases. Overall complication rates differed significantly among idiopathic, congenital, and neuromuscular cases (P < 0.001). Neuromuscular scoliosis had the highest rate of complications (17.9%), followed by congenital scoliosis (10.6%) and idiopathic scoliosis (6.3%). Rates of neurologic deficit also differed significantly based on the etiology of scoliosis (P < 0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%) and idiopathic scoliosis (0.8%). Neur-omuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurologic deficits were associated with revision procedures (P < 0.001) and with the use of corrective osteotomies (P < 0.001). The rates of new neurologic deficit were significantly higher for procedures using anterior screw-only constructs (2.0%) or wire-only constructs (1.7%), compared with pedicle screw-only constructs (0.7%) (P < 0.001).
In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups. These data may be useful for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.
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ABSTRACT: Background There are a number of syndromes that have historically been associated with scoliosis e.g.: Marfan, Down, and Neurofibromatosis. These syndromes have been grouped together as one etiology of scoliosis, known as syndromic scoliosis. While multiple studies indicate that these patients are at high risk for perioperative complications, there is a paucity of literature regarding the collective complication rates and surgical needs of this population. Methods PubMed and Embase databases were searched for literature encompassing the surgical complications associated with the surgical management of patients undergoing correction of scoliosis in the syndromic scoliosis population. Following exclusion criteria, 24 articles were analyzed for data regarding these complications. Results The collective complication rates and findings of these articles were categorized based on specific syndrome. The rates and types of complications for each syndrome and the special needs of patients with each syndrome are discussed. Several complication trends of note were observed, including but not limited to the universally nearly high rate of wound infections (>5% in each group), high rate of pulmonary complications in patients with Rett syndrome (29.2%), high rate (>10%) of dural tears in Marfan and Ehlers-Danlos syndrome patients, high rate (>20%) of implant failure in Down and Prader-Willi syndrome patients, and high rate (>25%) of pseudarthrosis in Down and Ehlers-Danlos patients. Conclusions Though these syndromes have been classically grouped together under the umbrella term “syndromic,” there may be specific needs for patients with each of these ailments. Given the high rate of complications, further research is necessary to understand the unique needs for each of these patient groups in the preoperative, intraoperative, and postoperative settings.Scoliosis 04/2015; 10(1). DOI:10.1186/s13013-015-0035-x · 1.31 Impact Factor
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ABSTRACT: To determine the median effective concentration of sufentanil as an analgesic during wake-up tests after sevoflurane anesthesia during surgery for adolescent idiopathic scoliosis (AIS). This is a randomised controlled trial. Sixty patients aged 13-18 years scheduled for AIS surgery were randomized into six groups of 10 patients each to receive target effect-site concentrations of sufentanil of 0.19, 0.1809, 0.1723, 0.1641, 0.1563, and 0.1489 ng/ml (target concentration ratio, 1.05). Wake-up time was recorded. Median EC50 and 95% confidence interval (CI) for sufentanil target-controlled infusion (TCI) were determined using Kärber's method. The primary outcome was median EC50 for sufentanil TCI as an analgesic during the wake-up test after sevoflurane anesthesia during surgery for AIS. The EC50 and 95% CI of sufentanil TCI were 0.1682 ng/ml and 0.1641 ~ 0.1724 ng/ml, respectively. The EC50 of sufentanil TCI was 0.1682 ng/ml (95% CI: 0.1641 ~ 0.1724 ng/ml) during sevoflurane anesthesia in adolescents undergoing surgery for idiopathic scoliosis with intraoperative wake-up tests. Clinicaltrials.gov identifier: ChiCTR-TTRCC-12002696.BMC Anesthesiology 03/2015; 15(1):27. DOI:10.1186/s12871-015-0003-2 · 1.33 Impact Factor
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ABSTRACT: Study Design. Observational cross-sectional population study using national sample of pediatric hospital discharges from 2000 through 2009.Objective. To determine whether there is an association between insurance status and in-hospital surgical outcome for pediatric patients with idiopathic scoliosis.Summary of Background Data. Association between health insurance status and in-hospital surgical outcome following spinal fusion for pediatric idiopathic scoliosis is unknown.Methods. An analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database 2000, 2003, 2006, and 2009 was performed. Patients aged 0 to <18 years with idiopathic scoliosis and no underlying neurologic disorders who underwent fusion were included. National trends, patient, hospital and surgical characteristics, postoperative in-hospital complications, and associated factors were studied. Univariate analysis and multivariable logistic regressions were used.Results. There were an estimated 19,439 surgeries (Medicaid 4,766 vs. Private 14,673) for pediatric idiopathic scoliosis from 2000 to 2009 in the U.S. Spinal fusions for pediatric idiopathic scoliosis steadily increased from 2000 to 2009 by 18.0%. Patients with private insurance were more likely to have surgery than Medicaid patients (7.7 vs. 5.9 per 100,000 capita, p = 0.003). Patients with private insurance were slightly older than Medicaid patients at the time of surgery (mean age 13.9 vs. 13.4 years, p<0.001). Medicaid patients had higher prevalence of asthma (10.8% vs. 7.4%, p<0.001), hypertension (1.4% vs. 0.4%, p<0.001), hyperlipidemia (0.3% vs. 0.1%, p = 0.01), diabetes (0.8% vs. 0.3%, p<0.001), and obesity (2.6% vs. 1.5%, p<0.001). Medicaid patients underwent more fusions involving ≥9 vertebrae than private patients (43.0% vs. 33.9%, p<0.001). Postoperative in-hospital complications were similar, including neurologic (Medicaid 1.8% vs. Private 1.7%, p = 0.64) and infectious (Medicaid 0.3% vs. Private 0.2%, p = 0.44). Length of stay was longer (6.1 vs. 5.6 days, p<0.001) and hospital costs higher ($45,443 vs. $41,635, p<0.001) for Medicaid patients. Surgery performed in the South and Midwest regions, older age, and female gender were associated with lower rates of in-hospital neurologic complications, while the presence of cardiac disease, obesity, and re-fusion were associated with higher rates of in-hospital neurologic complications.Conclusion. Medicaid patients were younger, underwent longer fusions, and had more medical comorbidities than patients with private insurance. However, insurance status was not associated with increased rate of postoperative in-hospital complications.Spine 12/2014; 40(4). DOI:10.1097/BRS.0000000000000729 · 2.45 Impact Factor