Charles M Chan1, Hasani W Swindell2, Hiroko Matsumoto3, Howard Y Park2, Joshua E Hyman2, Michael G Vitale2, David P Roye2, Benjamin D Roye2. 1. Department of Orthopaedic Surgery, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA. 2. Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA. 3. Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA. Electronic address: hm2174@columbia.edu.
Abstract
STUDY DESIGN: This study determines the rate of change in the scoliosis surgery plan in cases presented in preoperative indications conference. OBJECTIVES: To determine the effect of preoperative indications conference on the plan of surgery and to identify characteristics that increased the likelihood of change. SUMMARY OF BACKGROUND DATA: Preoperative indications conferences are used as a teaching and planning tool. Levels of fusion, construct options, and necessity for osteotomies are often debated in the planning of scoliosis surgery. METHODS: Scoliosis surgeries were presented at preoperative indications conference with four attending pediatric orthopedic surgeons present. The operative surgeon committed to a surgical plan before conference. A consensus-based plan was made without knowledge of the operative surgeon's preconference plan. Changes of plan were classified as major, minor, or no change. RESULTS: Of the 107 surgical plans, 50 were index surgeries, 13 were revisions, and 44 were scheduled growing rod lengthenings. There were two major changes, including a change to a growing construct from planned fusion, and a change in fusion levels in an adolescent idiopathic scoliosis (AIS) patient. There were 13 minor changes, which included changes in fusion levels (1 to 3; mean = 1.23) and the addition of an osteotomy. The rate of change was 28% for index surgeries and 7.69% for revisions. Of the 14 changes in the 50 index surgeries, there were 8 AIS, 3 cerebral palsy, 1 congenital scoliosis, 1 Ehlers-Danlos, and 1 patient with an undetermined neuromuscular condition. There was 1 change in 13 revision surgeries. There were no changes for growing rod lengthenings and no cancellations as a result of indications conference. CONCLUSIONS: Although revision scoliosis surgery is complex, index AIS/JIS surgery was most subject to the influence of indications conference. This likely reflects controversy around choosing levels of fusion. LEVEL OF EVIDENCE: IV.
STUDY DESIGN: This study determines the rate of change in the scoliosis surgery plan in cases presented in preoperative indications conference. OBJECTIVES: To determine the effect of preoperative indications conference on the plan of surgery and to identify characteristics that increased the likelihood of change. SUMMARY OF BACKGROUND DATA: Preoperative indications conferences are used as a teaching and planning tool. Levels of fusion, construct options, and necessity for osteotomies are often debated in the planning of scoliosis surgery. METHODS:Scoliosis surgeries were presented at preoperative indications conference with four attending pediatric orthopedic surgeons present. The operative surgeon committed to a surgical plan before conference. A consensus-based plan was made without knowledge of the operative surgeon's preconference plan. Changes of plan were classified as major, minor, or no change. RESULTS: Of the 107 surgical plans, 50 were index surgeries, 13 were revisions, and 44 were scheduled growing rod lengthenings. There were two major changes, including a change to a growing construct from planned fusion, and a change in fusion levels in an adolescent idiopathic scoliosis (AIS) patient. There were 13 minor changes, which included changes in fusion levels (1 to 3; mean = 1.23) and the addition of an osteotomy. The rate of change was 28% for index surgeries and 7.69% for revisions. Of the 14 changes in the 50 index surgeries, there were 8 AIS, 3 cerebral palsy, 1 congenital scoliosis, 1 Ehlers-Danlos, and 1 patient with an undetermined neuromuscular condition. There was 1 change in 13 revision surgeries. There were no changes for growing rod lengthenings and no cancellations as a result of indications conference. CONCLUSIONS: Although revision scoliosis surgery is complex, index AIS/JIS surgery was most subject to the influence of indications conference. This likely reflects controversy around choosing levels of fusion. LEVEL OF EVIDENCE: IV.
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