Mohan Belthur1, Liam Bosch2, William Wood1, Carla Boan1, Freeman Miller3, M Wade Shrader3. 1. Department of Orthopedics, Phoenix Children's Hospital, Phoenix, AZ, USA. 2. University of Arizona College of Medicine, Phoenix, AZ, USA. 3. Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Abstract
PURPOSE: Progressive scoliosis significantly impacts the quality of life in patients with cerebral palsy (CP). Spinal fusion is the mainstay of treatment of progressive spinal curves. The current study aims to identify approaches used by pediatric spine surgeons to optimize care of patients with CP undergoing scoliosis surgery. METHODS: A 33-question survey was distributed electronically to 181 POSNA/SRS members with an established interest in pediatric spinal deformity surgery. Eighty one responses were obtained (45%). Using the Delphi consensus guidelines, agreement > 75% was considered as consensus. RESULTS: There was a consensus on 15 out of 33 questions (46%). 97% of responders identified nutrition status as a comorbidity which could be optimized. However, the timing and method of obtaining nutritional assessment varied. 92% of the surgeons stated that they used shared decision making with the family but only 22% used a formal decision aid. 83% use antifibrinolytics routinely, 81% used a surgical site infection prevention protocol, 78% obtained preoperative pulmonary consult, and 88% took steps postoperatively to prevent pulmonary complications. CONCLUSION: There is significant variability in the current practices of perioperative management of patients with CP undergoing scoliosis surgery. This data can be used in future studies to create a standardized integrated care pathway.
PURPOSE: Progressive scoliosis significantly impacts the quality of life in patients with cerebral palsy (CP). Spinal fusion is the mainstay of treatment of progressive spinal curves. The current study aims to identify approaches used by pediatric spine surgeons to optimize care of patients with CP undergoing scoliosis surgery. METHODS: A 33-question survey was distributed electronically to 181 POSNA/SRS members with an established interest in pediatric spinal deformity surgery. Eighty one responses were obtained (45%). Using the Delphi consensus guidelines, agreement > 75% was considered as consensus. RESULTS: There was a consensus on 15 out of 33 questions (46%). 97% of responders identified nutrition status as a comorbidity which could be optimized. However, the timing and method of obtaining nutritional assessment varied. 92% of the surgeons stated that they used shared decision making with the family but only 22% used a formal decision aid. 83% use antifibrinolytics routinely, 81% used a surgical site infection prevention protocol, 78% obtained preoperative pulmonary consult, and 88% took steps postoperatively to prevent pulmonary complications. CONCLUSION: There is significant variability in the current practices of perioperative management of patients with CP undergoing scoliosis surgery. This data can be used in future studies to create a standardized integrated care pathway.
Authors: Ariana T Meltzer-Bruhn; Matthew R Landrum; David A Spiegel; Patrick J Cahill; Jason B Anari; Keith D Baldwin Journal: Spine Deform Date: 2021-08-24
Authors: Nathan J Lee; Michael Fields; Venkat Boddapati; Justin Mathew; Daniel Hong; Zeeshan M Sardar; Paulo R Selber; Benjamin Roye; Michael G Vitale; Lawrence G Lenke Journal: Global Spine J Date: 2020-09-23