Jason B Anari1, John M Flynn2, Patrick J Cahill2, Michael G Vitale3, John T Smith4, Jaime A Gomez5, Sumeet Garg6, Keith D Baldwin2. 1. The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA. anarij@email.chop.edu. 2. The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA. 3. New York-Presbyterian/Morgan Stanley Children's Hospital, 3959 Broadway Rm 800N, New York, NY, 10032, USA. 4. University of Utah, 1590 Wakara Way, Salt Lake City, UT, 84108, USA. 5. Montefiore Medical Center Medical Arts Pavilion, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA. 6. Children's Hospital Colorado, 13123 East 16th Ave, Auroa, CO, 80045, USA.
Abstract
STUDY DESIGN: Retrospective analysis of a prospectively collected multicenter database. OBJECTIVES: Our goal was to study unplanned return to the OR (UPROR, a postoperative complication that could not be treated without an additional anesthetic) as a function of C-EOS diagnosis and implant type. Growing concerns over the impact of multiple anesthetic events on the young brain have focused attention on limiting UPROR in early onset scoliosis (EOS). METHODS: We studied all patients with a diagnosis of EOS who had surgical implantation of growing instrumentation from October 4, 2010, to September 27, 2015, with a minimum 2-year follow-up. Among the complications requiring surgical treatment (revision for implant or anchor failure, infection, or implant removal), we analyzed all UPROR events-those that required a separate anesthetic (could not be treated as part of a planned surgical lengthening) within the first 2 years after initial implantation. UPROR was analyzed by diagnosis, deformity type, and implant strategy using the C-EOS classification. RESULTS: A total of 369 patients met inclusion criteria. Eighty-five of the 369 (23%) required unplanned trips to the operating room for various reasons. The C-EOS group at highest risk of an unplanned trip to the operating room is the hyperkyphotic neuromuscular (M3+, 14/85) cohort, followed closely by the congenital (C3N, 9/85) and neuromuscular (M3N, 8/85) groups with normal sagittal profiles and Cobb angles between 50° and 90°. Implant strategy was significantly related to risk of UPROR (p = .009; Table 1), with traditional implants (vertically expandable prosthetic titanium rib/traditional growing rod) being less likely to have an UPROR event. CONCLUSIONS: Growing instrumentation to treat EOS, when considered comprehensively, results in a true unplanned reoperation rate within 2 years of implantation of 23% (85/369). UPROR events are more common with certain C-EOS groups (hyperkyphotic neuromuscular deformities) and implant strategies. Families should be counseled that unplanned anesthetics are common with any implant strategy available today. LEVEL OF EVIDENCE: Level III, therapeutic.
STUDY DESIGN: Retrospective analysis of a prospectively collected multicenter database. OBJECTIVES: Our goal was to study unplanned return to the OR (UPROR, a postoperative complication that could not be treated without an additional anesthetic) as a function of C-EOS diagnosis and implant type. Growing concerns over the impact of multiple anesthetic events on the young brain have focused attention on limiting UPROR in early onset scoliosis (EOS). METHODS: We studied all patients with a diagnosis of EOS who had surgical implantation of growing instrumentation from October 4, 2010, to September 27, 2015, with a minimum 2-year follow-up. Among the complications requiring surgical treatment (revision for implant or anchor failure, infection, or implant removal), we analyzed all UPROR events-those that required a separate anesthetic (could not be treated as part of a planned surgical lengthening) within the first 2 years after initial implantation. UPROR was analyzed by diagnosis, deformity type, and implant strategy using the C-EOS classification. RESULTS: A total of 369 patients met inclusion criteria. Eighty-five of the 369 (23%) required unplanned trips to the operating room for various reasons. The C-EOS group at highest risk of an unplanned trip to the operating room is the hyperkyphotic neuromuscular (M3+, 14/85) cohort, followed closely by the congenital (C3N, 9/85) and neuromuscular (M3N, 8/85) groups with normal sagittal profiles and Cobb angles between 50° and 90°. Implant strategy was significantly related to risk of UPROR (p = .009; Table 1), with traditional implants (vertically expandable prosthetic titanium rib/traditional growing rod) being less likely to have an UPROR event. CONCLUSIONS: Growing instrumentation to treat EOS, when considered comprehensively, results in a true unplanned reoperation rate within 2 years of implantation of 23% (85/369). UPROR events are more common with certain C-EOS groups (hyperkyphotic neuromuscular deformities) and implant strategies. Families should be counseled that unplanned anesthetics are common with any implant strategy available today. LEVEL OF EVIDENCE: Level III, therapeutic.
Entities:
Keywords:
C-EOS classification; Early onset scoliosis; Growing instrumentation; Unplanned return to OR
Authors: Abdullah Abdullah; Stefan Parent; Firoz Miyanji; Kevin Smit; Joshua Murphy; David Skaggs; Purnendu Gupta; Michael Vitale; Jean Ouellet; Neil Saran; Robert H Cho; Pediatric Spine Study Group; Ron El-Hawary Journal: Spine Deform Date: 2021-04-09
Authors: Ying Li; Jennylee Swallow; Joel Gagnier; John T Smith; Robert F Murphy; Paul D Sponseller; Patrick J Cahill Journal: Spine Deform Date: 2022-01-23