A new study published in Spine examines national trends for pediatric idiopathic scoliosis patients undergoing spinal fusion.
The researchers examined the Nationwide Inpatient Sample database to identify patients for the study. The patients underwent spinal fusion for AIS from 2000 to 2009 and the researchers tracked their outcomes. The study included 43,983 patients and found:
1. There were 30.4 percent who received blood transfusion. The predonated autologous blood transfusions decreased overtime whereas perioperative autologous blood transfusions increased. The study authors noted strategies for blood transfusion methods changed over the years.
There are 38,000 patients who undergo spinal fusion for scoliosis each year, according to the National Scoliosis Foundation. Another 30,000 children are put into a brace for scoliosis.
2. The in-hospital complication rate was 14.4 percent. Overall the respiratory complication rate was the highest among all complications, but decreased overtime. A study of more than 500 patients published earlier this year in the Journal of Bone & Joint Surgery found patients who undergo spinal fusion for AIS during the months of June and July — when new residents and fellows are beginning to assist surgeons — were not at a higher risk of complications than patients who underwent surgery at different times of the year.
Additionally, June and July were not associated with higher rates of blood loss, operative time or length of stay at the hospital. The only distinguishing factor was preoperative pain scores, which was worse for patients undergoing surgery in February.
3. The complication, in-hospital blood transfusion and mortality rates were higher among patients with an increased Elixhauser Comorbidity Score and those who underwent anterior and posterior fusion.
4. The average length of stay at the hospital decreased overtime. "A decreasing trend in respiratory complication rate and reduction in length of stay may indicate better postoperative care," concluded the study authors.
Another study published earlier this year of patients who underwent spinal fusion for AIS examined potential clinical and economic implications for early discharge. After following 365 patients who underwent surgery and were placed either on the regular discharge track or the accelerated discharge pathway — which averaged 1.36 fewer days of inpatient stay — the researchers found no increase in early complication rate and a small decrease in hospital charges. Hospital costs were $2,779 among the patients with regular length of stay, compared to $1,885 among those in the accelerated discharge program.
5. A separate article published in a 2012 edition of the Journal of Orthopedic Surgery found that athletically active adolescents who underwent posterior spinal fusion for AIS were sometimes able to return to their sport at the same or higher level of physical activity. At five-and-a-half years after surgery, 59.5 percent of the patients returned to their activity with at least equal level of play. Lenke classification and final SRS-22 scores were predictive of return to activity, and no complications related to return to play were reported.
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