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Scientific Articles   |    
Is Larger Scoliosis Curve Magnitude Associated with Increased Perioperative Health-Care Resource Utilization?A Multicenter Analysis of 325 Adolescent Idiopathic Scoliosis Curves
Firoz Miyanji, MD, FRCSC1; Gerard P. Slobogean, MD, MPH2; Amer F. Samdani, MD3; Randal R. Betz, MD3; Christopher W. Reilly, MD, FRCSC2; Bronwyn L. Slobogean, PA-C1; Peter O. Newton, MD4
1 Department of Orthopedics, British Columbia Children’s Hospital, A200-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. E-mail address for F. Miyanji: fmiyanji@cw.bc.ca
2 Department of Orthopaedics, University of British Columbia, 3114-910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada
3 Department of Orthopedics, Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140-4131
4 Department of Orthopedics, Rady Children’s Hospital, 410-3030 Children’s Way, San Diego, CA 921234
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  • Disclosure statement for author(s): PDF

Investigation performed at British Columbia Children’s Hospital, Vancouver, British Columbia, Canada



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 02;94(9):809-813. doi: 10.2106/JBJS.J.01682
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Abstract

Background: 

The treatment of patients with large adolescent idiopathic scoliosis curves has been associated with increased surgical complexity. The purpose of this study was to determine whether surgical correction of larger adolescent idiopathic scoliosis curves increased the utilization of health-care resources and to identify potential predictors associated with increased perioperative health-care resource utilization.

Methods: 

A nested cohort of patients with adolescent idiopathic scoliosis with Lenke type 1A and 1B curves were identified from a prospective longitudinal multicenter database. Four perioperative outcomes were selected as the primary health-care resource utilization outcomes of interest: operative time, number of vertebral levels instrumented, duration of hospitalization, and allogeneic blood transfusion. The effect of curve magnitude on these outcomes was assessed with use of univariate and multivariate regression.

Results: 

Three hundred and twenty-five patients with a mean age of 15 ± 2 years were included. The mean main thoracic curve was 54.4° ± 7.8°. Larger curves were associated with longer operative time (p = 0.03), a greater number of vertebral levels instrumented (p = 0.0005), and the need for blood transfusion (with every 10° increase associated with 1.5 times higher odds of receiving a transfusion). In addition to curve magnitude, surgical center, bone graft method, and upper and lower instrumented levels were strong predictors of operative time (R2 = 0.76). The duration of hospitalization was influenced by the surgical center and intraoperative blood loss (R2 < 0.4), whereas the number of levels instrumented was influenced by the curve magnitude, curve correction percentage, upper instrumented vertebra, and surgical center (R2 = 0.64).

Conclusions: 

Correction of larger curves was associated with increased utilization of perioperative health-care resources, specifically longer operative time, a greater number of vertebral levels instrumented, and higher odds of receiving a blood transfusion.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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