Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function.

Autor: Tarrant RC; Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland. roslyn.tarrant@olchc.ie.; The National Children's Research Centre, Crumlin, Dublin, 12, Ireland. roslyn.tarrant@olchc.ie., Queally JM; Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland., O'Loughlin PF; Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland., Sheeran P; Department of Anaesthetics, Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland.; Blackrock Clinic, Blackrock, Co, Dublin, Ireland., Moore DP; Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland.; Blackrock Clinic, Blackrock, Co, Dublin, Ireland., Kiely PJ; Department of Orthopaedic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, 12, Ireland.; Blackrock Clinic, Blackrock, Co, Dublin, Ireland.
Jazyk: angličtina
Zdroj: Irish journal of medical science [Ir J Med Sci] 2016 May; Vol. 185 (2), pp. 463-71. Date of Electronic Publication: 2016 Jan 07.
DOI: 10.1007/s11845-015-1391-5
Abstrakt: Background: Surgical procedures to correct larger curve magnitudes >70° in patients with adolescent idiopathic scoliosis (AIS) are still common; despite their increased complexity, limited research has assessed the effect of preoperative curve severity on outcomes.
Aim: This study aimed to examine the impact of preoperative curves >70° vs. those ≤70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF).
Methods: Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to preoperative function was reported. Preoperative curves >70° vs. ≤70° were analysed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient.
Results: Severe preoperative curves >70°, identified in 21 patients (27.3 %), were associated with significantly longer surgical duration (median 6.5 vs. 5 h, p = 0.001) and increased blood loss (median 1250 vs. 1000 ml, p = 0.005)-these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, CI 1.4-2.7, p = 0.004). Curves >70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 vs. €28,620, p < 0.0001).
Conclusion: Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves >70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.
Databáze: MEDLINE
Externí odkaz: