Tracy Ruska1, Thomas M Austin2, Robert W Bruce1, Nicholas D Fletcher3. 1. Department of Orthopaedic Surgery, Clinical Practice Group, Children's Healthcare of Atlanta, 1400 Tullie Rd NE, Atlanta, GA, 30329, USA. 2. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA. 3. Department of Orthopaedic Surgery, Clinical Practice Group, Children's Healthcare of Atlanta, 1400 Tullie Rd NE, Atlanta, GA, 30329, USA. Nicholas.d.fletcher@emory.edu.
Abstract
INTRODUCTION: Posterior spinal fusion (PSF) represents a large physiologic challenge for children with neuromuscular scoliosis (NMS). Perioperative complications are numerous with many occurring in the post-operative period due to pain and relative immobilization. This study assessed the impact of steroids on patients undergoing PSF for NMS. METHODS: A retrospective review of consecutive patients managed at a single center with PSF for NMS was reviewed. Clinical and radiographic analysis was used to evaluate baseline demographics, curve characteristics, and post-operative course. RESULTS: Eighty-nine patients who underwent PSF for NMS were included. Fifty-seven of these patients did not receive post-operative steroids (NS) while 32 patients were treated with post-operative steroids (dexamethasone, WS) for a median of 3 doses (median 6.0 mg/dose every 8 h after surgery). The demographic variables of the cohorts were similar with no difference in curve magnitude, number of vertebrae fused, number of osteotomies, or EBL between groups. A 70% decrease in the median post-operative morphine equivalents was observed in the steroid cohort (0.50 mg/kg WS vs 1.65 mg/kg NS, p value < 0.001). There was an association between post-operative morphine equivalents and length of stay (Spearman's rho = 0.22, p value = 0.04). There was no difference in wound healing, infection, and pulmonary or gastrointestinal complications between groups. No difference was found in pain at discharge, 30-day ED returns, or 30-day OR returns between groups. CONCLUSIONS: Post-operative dexamethasone resulted in a 70% decrease in morphine equivalent use after PSF for NMS without any increase in perioperative wound infections. LEVEL OF EVIDENCE: Level 3: case-control series.
INTRODUCTION: Posterior spinal fusion (PSF) represents a large physiologic challenge for children with neuromuscular scoliosis (NMS). Perioperative complications are numerous with many occurring in the post-operative period due to pain and relative immobilization. This study assessed the impact of steroids on patients undergoing PSF for NMS. METHODS: A retrospective review of consecutive patients managed at a single center with PSF for NMS was reviewed. Clinical and radiographic analysis was used to evaluate baseline demographics, curve characteristics, and post-operative course. RESULTS: Eighty-nine patients who underwent PSF for NMS were included. Fifty-seven of these patients did not receive post-operative steroids (NS) while 32 patients were treated with post-operative steroids (dexamethasone, WS) for a median of 3 doses (median 6.0 mg/dose every 8 h after surgery). The demographic variables of the cohorts were similar with no difference in curve magnitude, number of vertebrae fused, number of osteotomies, or EBL between groups. A 70% decrease in the median post-operative morphine equivalents was observed in the steroid cohort (0.50 mg/kg WS vs 1.65 mg/kg NS, p value < 0.001). There was an association between post-operative morphine equivalents and length of stay (Spearman's rho = 0.22, p value = 0.04). There was no difference in wound healing, infection, and pulmonary or gastrointestinal complications between groups. No difference was found in pain at discharge, 30-day ED returns, or 30-day OR returns between groups. CONCLUSIONS: Post-operative dexamethasone resulted in a 70% decrease in morphine equivalent use after PSF for NMS without any increase in perioperative wound infections. LEVEL OF EVIDENCE: Level 3: case-control series.
Authors: Nicholas D Fletcher; Tracy Ruska; Thomas M Austin; Ndeye F Guisse; Joshua S Murphy; Robert W Bruce Journal: J Bone Joint Surg Am Date: 2020-10-21 Impact factor: 5.284
Authors: Jorinde Aw Polderman; Violet Farhang-Razi; Susan Van Dieren; Peter Kranke; J Hans DeVries; Markus W Hollmann; Benedikt Preckel; Jeroen Hermanides Journal: Cochrane Database Syst Rev Date: 2018-11-23