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: 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; 15:27. DOI:10.1186/s12871-015-0003-2 · 1.33 Impact Factor
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ABSTRACT: Study Design. Retrospective analysis of prospectively collected data from the 2001-2010 Nationwide Inpatient Sample (NIS) database.Objective. To assess complication rates in adolescent spinal deformity by surgeon operative volume for procedures with a range of complexity.Summary of Background Data. Surgeons performing higher volumes of lumbar spinal fusion have been associated with improved surgical outcomes, according to studies using the NIS. This relationship has not been shown in adolescent spinal deformity surgery.Methods. The NIS was queried for patients age 10-18 with in-hospital stays including spinal arthrodesis for scoliosis [adolescent idiopathic, neuromuscular (NMS) and congenital scoliosis (CS)]. The primary endpoint was hospital stay morbidity: database-defined surgical, mechanical, major medical and neurological complications. Length of stay (LOS) and hospital charges were also analyzed. Annual surgeon volumes were stratified into quartiles based on number of cases (Q1:1, Q2: 2-7, Q3:8-19, Q4: 20-97). To account for variation in surgical invasiveness, an operative complexity index was used. One-way ANOVA was used to assess differences between quartiles for continuous measures, chi-square for categorical measures.Results. 6,100 spine fusion cases met inclusion criteria for adolescent scoliosis. All complications categories were less frequent for higher volume surgeons after a primary fusion for all diagnoses. This pattern held for increasing surgical invasiveness, such as fusing ≥9 levels and became more distinct for neurologic complications when comparing surgeons performing combined anterior-posterior procedures. Including all adolescent scoliosis fusions, higher surgical volume was associated with decreased LOS and hospital charges.Conclusion. Perioperative complications after adolescent scoliosis fusion surgery are more frequent in lower volume settings. This may reflect a learning curve required for more complex cases as the trends are magnified in NMS/CS cases or simply that higher volume surgeons are more adept at these fusions. The impact of volume on reduced LOS and hospital charges has implications for future healthcare economics measures.Spine 11/2014; DOI:10.1097/BRS.0000000000000710 · 2.45 Impact Factor
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ABSTRACT: This article reviews the incidence, management, and complications of scoliosis in patients with cerebral palsy. Treatment of scoliosis in patients with cerebral palsy includes both nonoperative and operative management and often the decision to proceed with surgery is a multidisciplinary decision. Because of severe spasticity, many of these patients undergo intrathecal baclofen pump placement before, during, or after posterior spinal fusion. The complication rates can be high with intrathecal baclofen pump placement, but many patients can have significant benefit with this therapy. Copyright © 2015 Elsevier Inc. All rights reserved.Physical Medicine and Rehabilitation Clinics of North America 02/2015; 26(1):79-88. DOI:10.1016/j.pmr.2014.09.003 · 1.09 Impact Factor