Operative Duration Predictors in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis in RSUP Dr. Hasan Sadikin, Bandung
DOI:
https://doi.org/10.31282/joti.v5n3.106Keywords:
Adolescent Idiopathic Scoliosis, Spine, Ooperative DurationAbstract
Background : Untreated adolescent idiopathic scoliosis (AIS) can cause curve progression, back pain, and cardiopulmonary problems in addition to psychosocial issues. Operative intervention for AIS patients is a complex procedure with long duration. There are many variables that can determine operation duration. This study aims to identify factors that predict variation in the duration of posterior spinal fusion (PSF) in AIS patients.
Methods: 21 medical records of patients undergoing scoliosis deformity correction at RSUP Dr. Hasan Sadikin between January 2022 to December 2022 was analyzed retrospectively. Various variables relate to patients, procedures, and surgeons that are considered to influence the duration operation were analyzed through multivariate regression to determine the independent variable as a predictor of surgery duration.
Results : The final model obtained from multivariate regression analysis include Cobb’s angle of the major structural curve (β = 0.35) and the number of screws inserted (β = 0.28). Operative duration had a significant correlation with estimated blood loss, need for operative blood transfusion, and length of hospital stay.
Conclusions : Out of several variables that predict operative duration during PSF in AIS patients that were identified, curve severity is the strongest predictor.
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References
Choudhry MN, Ahmad Z, Verma R. Adolescent idiopathic scoliosis. Open Orthop J. 2016;10:143–54.
Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Vol. 13, Scoliosis and Spinal Disorders. Scoliosis and Spinal Disorders; 2018. 1–48 p.
Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):3–9.
Kikanloo SR, Tarpada SP, Cho W. Etiology of adolescent idiopathic scoliosis: A literature review. Asian Spine J. 2019;13(3):519–26.
Grauers A, Einarsdottir E, Gerdhem P. Genetics and pathogenesis of idiopathic scoliosis. Scoliosis Spinal Disord [Internet]. 2016;11(1):1–7. Available from: http://dx.doi.org/10.1186/s13013-016-0105-8
Addai D, Zarko J, Bowey AJ. Current Concepts in the Diagnosis and Management of Adolescent Idiopathic Scoliosis. Child’s Nerv Syst. 2020;36:1111–9.
Tambe AD, Panikkar SJ, Millner PA, Tsirikos AI. Current concepts in the surgical management of adolescent idiopathic scoliosis. Bone Jt J. 2018;100B(4):415–24.
Al-Mohrej OA, Aldakhil SS, Al-Rabiah MA, Al-Rabiah AM. Surgical treatment of adolescent idiopathic scoliosis: Complications. Ann Med Surg. 2020;52(January):19–23.
Mehta N, Garg B, Bansal T, Aryal A, Arora N, Gupta V. Predictors of Operative Duration in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis : A Retrospective Cohort Study Predictors of Operative Duration in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis : A Retrospective Cohort Study. 2023;16(3):559–66.
Eijkemans MJ., Houdenhoven M Van, Nguyen T, Boersma E, Steyerberg EW, Kazemier G. Predicting the unpredictable. Hear Anesthesiol. 2010;112(1):41–9.
Minhas S V., Chow I, Bosco J, Otsuka NY. Assessing the Rates, Predictors, and Complications of Blood Transfusion Volume in Posterior Arthrodesis for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2015;40(18):1422–30.
Dupuis C, Michelet D, Hilly J, Diallo T, Vidal C, Delivet H, et al. Predictive factors for homologous transfusion during paediatric scoliosis surgery. Anaesth Crit Care Pain Med. 2015;34(6):327–32.
Puffer RC, Murphy M, Maloney P, Kor D, Nassr A, Freedman B, et al. Increased Total Anesthetic Time Leads to Higher Rates of Surgical Site Infections in Spinal Fusions. Spine (Phila Pa 1976). 2017;42(11):E687–90.
Glotzbecker MP, Riedel MD, Vitale MG, Matsumoto H, Roye DP, Erickson M, et al. What’s the evidence? systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. J Pediatr Orthop. 2013;33(5):479–87.
Carreon LY, Puno RM, Lenke LG, Richards BS, Sucato DJ, Emans JB, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Jt Surg. 2007;89(11):2427–32.
Hod-Feins R, Abu-Kishk I, Eshel G, Barr Y, Anekstein Y, Mirovsky Y. Risk factors affecting the immediate postoperative course in pediatric scoliosis surgery. Spine (Phila Pa 1976). 2007;32(21):2355–60.
Hardesty CK, Poe-Kochert C, Son-Hing JP, Thompson GH. Obesity negatively affects spinal surgery in idiopathic scoliosis. Clin Orthop Relat Res. 2013;471(4):1230–5.
Miyanji F, Slobogean GP, Samdani AF, Betz RR, Reilly CW, Slobogean BL, et al. Is Larger Scoliosis Curve Magnitude Associated with Increased Perioperative Health-Care Resource Utilization? J Bone Jt Surg. 2012;94(9):809–13.
Nugent M, Tarrant RC, Queally JM, Sheeran P, Moore DP, Kiely PJ. Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis. Ir J Med Sci. 2016;185(2):513–20.
Heller A, Melvani R, Thome A, Leamon J, Schwend RM. Predictors of variability in the length of surgery of posterior instrumented arthrodesis in patients with adolescent idiopathic scoliosis. J Pediatr Orthop Part B. 2016;25(3):258–62.
Ryu KJ, Suh SW, Kim HW, Lee DH, Yoon Y, Hwang JH. Quantitative analysis of a spinal surgeon’s learning curve for scoliosis surgery. Bone Jt J. 2016;98(5):679–85.
Quan GMY, Gibson MJ. Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: Does higher implant density improve correction? Spine (Phila Pa 1976). 2010;35(5):562–7.
Bharucha NJ, Lonner BS, Auerbach JD, Kean KE, Trobisch PD. Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis: Do more screws lead to a better outcome? Spine J [Internet]. 2013;13(4):375–81. Available from: http://dx.doi.org/10.1016/j.spinee.2012.05.029
Czerwein J, Thornhill B, Amaral T, Wollowick A, Sharan A, Sarwahi V. Does CT based pedicle morphology correlate with degree of curve rotation grade or level of apex? Spine J. 2008;8(5):145S-146S.
Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Sugarman E, Lo Y, et al. MRIs Are Less Accurate Tools for the Most Critically Worrisome Pedicles Compared to CT Scans. Spine Deform [Internet]. 2016;4(6):400–6. Available from: http://dx.doi.org/10.1016/j.jspd.2016.08.002
Cahill PJ, Pahys JM, Asghar J, Yaszay B, Marks MC, Bastrom TP, et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Jt Surg - Am Vol. 2014;96(16):1333–9.
Choudhry MN, Ahmad Z, Verma R. Adolescent idiopathic scoliosis. Open Orthop J. 2016;10:143–54.
Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Vol. 13, Scoliosis and Spinal Disorders. Scoliosis and Spinal Disorders; 2018. 1–48 p.
Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):3–9.
Kikanloo SR, Tarpada SP, Cho W. Etiology of adolescent idiopathic scoliosis: A literature review. Asian Spine J. 2019;13(3):519–26.
Grauers A, Einarsdottir E, Gerdhem P. Genetics and pathogenesis of idiopathic scoliosis. Scoliosis Spinal Disord [Internet]. 2016;11(1):1–7. Available from: http://dx.doi.org/10.1186/s13013-016-0105-8
Addai D, Zarko J, Bowey AJ. Current Concepts in the Diagnosis and Management of Adolescent Idiopathic Scoliosis. Child’s Nerv Syst. 2020;36:1111–9.
Tambe AD, Panikkar SJ, Millner PA, Tsirikos AI. Current concepts in the surgical management of adolescent idiopathic scoliosis. Bone Jt J. 2018;100B(4):415–24.
Al-Mohrej OA, Aldakhil SS, Al-Rabiah MA, Al-Rabiah AM. Surgical treatment of adolescent idiopathic scoliosis: Complications. Ann Med Surg. 2020;52(January):19–23.
Mehta N, Garg B, Bansal T, Aryal A, Arora N, Gupta V. Predictors of Operative Duration in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis : A Retrospective Cohort Study Predictors of Operative Duration in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis : A Retrospective Cohort Study. 2023;16(3):559–66.
Eijkemans MJ., Houdenhoven M Van, Nguyen T, Boersma E, Steyerberg EW, Kazemier G. Predicting the unpredictable. Hear Anesthesiol. 2010;112(1):41–9.
Minhas S V., Chow I, Bosco J, Otsuka NY. Assessing the Rates, Predictors, and Complications of Blood Transfusion Volume in Posterior Arthrodesis for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2015;40(18):1422–30.
Dupuis C, Michelet D, Hilly J, Diallo T, Vidal C, Delivet H, et al. Predictive factors for homologous transfusion during paediatric scoliosis surgery. Anaesth Crit Care Pain Med. 2015;34(6):327–32.
Puffer RC, Murphy M, Maloney P, Kor D, Nassr A, Freedman B, et al. Increased Total Anesthetic Time Leads to Higher Rates of Surgical Site Infections in Spinal Fusions. Spine (Phila Pa 1976). 2017;42(11):E687–90.
Glotzbecker MP, Riedel MD, Vitale MG, Matsumoto H, Roye DP, Erickson M, et al. What’s the evidence? systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. J Pediatr Orthop. 2013;33(5):479–87.
Carreon LY, Puno RM, Lenke LG, Richards BS, Sucato DJ, Emans JB, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Jt Surg. 2007;89(11):2427–32.
Hod-Feins R, Abu-Kishk I, Eshel G, Barr Y, Anekstein Y, Mirovsky Y. Risk factors affecting the immediate postoperative course in pediatric scoliosis surgery. Spine (Phila Pa 1976). 2007;32(21):2355–60.
Hardesty CK, Poe-Kochert C, Son-Hing JP, Thompson GH. Obesity negatively affects spinal surgery in idiopathic scoliosis. Clin Orthop Relat Res. 2013;471(4):1230–5.
Miyanji F, Slobogean GP, Samdani AF, Betz RR, Reilly CW, Slobogean BL, et al. Is Larger Scoliosis Curve Magnitude Associated with Increased Perioperative Health-Care Resource Utilization? J Bone Jt Surg. 2012;94(9):809–13.
Nugent M, Tarrant RC, Queally JM, Sheeran P, Moore DP, Kiely PJ. Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis. Ir J Med Sci. 2016;185(2):513–20.
Heller A, Melvani R, Thome A, Leamon J, Schwend RM. Predictors of variability in the length of surgery of posterior instrumented arthrodesis in patients with adolescent idiopathic scoliosis. J Pediatr Orthop Part B. 2016;25(3):258–62.
Ryu KJ, Suh SW, Kim HW, Lee DH, Yoon Y, Hwang JH. Quantitative analysis of a spinal surgeon’s learning curve for scoliosis surgery. Bone Jt J. 2016;98(5):679–85.
Quan GMY, Gibson MJ. Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: Does higher implant density improve correction? Spine (Phila Pa 1976). 2010;35(5):562–7.
Bharucha NJ, Lonner BS, Auerbach JD, Kean KE, Trobisch PD. Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis: Do more screws lead to a better outcome? Spine J [Internet]. 2013;13(4):375–81. Available from: http://dx.doi.org/10.1016/j.spinee.2012.05.029
Czerwein J, Thornhill B, Amaral T, Wollowick A, Sharan A, Sarwahi V. Does CT based pedicle morphology correlate with degree of curve rotation grade or level of apex? Spine J. 2008;8(5):145S-146S.
Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Sugarman E, Lo Y, et al. MRIs Are Less Accurate Tools for the Most Critically Worrisome Pedicles Compared to CT Scans. Spine Deform [Internet]. 2016;4(6):400–6. Available from: http://dx.doi.org/10.1016/j.jspd.2016.08.002
Cahill PJ, Pahys JM, Asghar J, Yaszay B, Marks MC, Bastrom TP, et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Jt Surg - Am Vol. 2014;96(16):1333–9.
