Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function

• Published in: Irish journal of medical science 2016-05, Vol.185 (2), p.463-471
• Main Authors: Tarrant, R. C., Queally, J. M., O’Loughlin, P. F., Sheeran, P., Moore, D. P., Kiely, P. J.
• Format: Article
• Language: English
• Subjects: Adolescent; Blood Loss, Surgical; Blood Transfusion; Family Medicine; Female; General Practice; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Original Article; Prospective Studies; Scoliosis - surgery; Spinal Fusion - methods; Time Factors; Treatment Outcome
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-015-1391-5

Background Surgical procedures to correct larger curve magnitudes >70° in patients with adolescent idiopathic scoliosis (AIS) are still common; despite their increased complexity, limited research has assessed the effect of preoperative curve severity on outcomes. Aim This study aimed to examine the impact of preoperative curves >70° vs. those ≤70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF). Methods Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to preoperative function was reported. Preoperative curves >70° vs. ≤70° were analysed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient. Results Severe preoperative curves >70°, identified in 21 patients (27.3 %), were associated with significantly longer surgical duration (median 6.5 vs. 5 h, p  = 0.001) and increased blood loss (median 1250 vs. 1000 ml, p  = 0.005)—these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, CI 1.4–2.7, p  = 0.004). Curves >70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 vs. €28,620, p  70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.