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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

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...

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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.
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container_title Irish journal of medical science
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Queally, J. M.
O’Loughlin, P. F.
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Moore, D. P.
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description 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.
doi_str_mv 10.1007/s11845-015-1391-5
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C. ; Queally, J. M. ; O’Loughlin, P. F. ; Sheeran, P. ; Moore, D. P. ; Kiely, P. J.</creator><creatorcontrib>Tarrant, R. C. ; Queally, J. M. ; O’Loughlin, P. F. ; Sheeran, P. ; Moore, D. P. ; Kiely, P. J.</creatorcontrib><description>Background Surgical procedures to correct larger curve magnitudes &gt;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 &gt;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 &gt;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 &gt;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 &gt;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  &lt; 0.0001). Conclusion Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves &gt;70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.</description><identifier>ISSN: 0021-1265</identifier><identifier>EISSN: 1863-4362</identifier><identifier>DOI: 10.1007/s11845-015-1391-5</identifier><identifier>PMID: 26742534</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Adolescent ; Blood Loss, Surgical ; Blood Transfusion ; Family Medicine ; Female ; General Practice ; Humans ; Internal Medicine ; Male ; Medicine ; Medicine &amp; Public Health ; Original Article ; Prospective Studies ; Scoliosis - surgery ; Spinal Fusion - methods ; Time Factors ; Treatment Outcome</subject><ispartof>Irish journal of medical science, 2016-05, Vol.185 (2), p.463-471</ispartof><rights>Royal Academy of Medicine in Ireland 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-30b9723c1f553f928ae923861771269025e39ed9080bf58da39aeef93dda3ee23</citedby><cites>FETCH-LOGICAL-c344t-30b9723c1f553f928ae923861771269025e39ed9080bf58da39aeef93dda3ee23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26742534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tarrant, R. C.</creatorcontrib><creatorcontrib>Queally, J. M.</creatorcontrib><creatorcontrib>O’Loughlin, P. F.</creatorcontrib><creatorcontrib>Sheeran, P.</creatorcontrib><creatorcontrib>Moore, D. P.</creatorcontrib><creatorcontrib>Kiely, P. J.</creatorcontrib><title>Preoperative curves of greater magnitude (&gt;70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function</title><title>Irish journal of medical science</title><addtitle>Ir J Med Sci</addtitle><addtitle>Ir J Med Sci</addtitle><description>Background Surgical procedures to correct larger curve magnitudes &gt;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 &gt;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 &gt;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 &gt;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 &gt;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  &lt; 0.0001). Conclusion Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves &gt;70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.</description><subject>Adolescent</subject><subject>Blood Loss, Surgical</subject><subject>Blood Transfusion</subject><subject>Family Medicine</subject><subject>Female</subject><subject>General Practice</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine &amp; Public Health</subject><subject>Original Article</subject><subject>Prospective Studies</subject><subject>Scoliosis - surgery</subject><subject>Spinal Fusion - methods</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0021-1265</issn><issn>1863-4362</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1DAUhS0EosPAA7BBXhapaf2TP2-QqooCUiW6gLXlsW8yrpI4-DqFeSueoTveCkdTumRlWz73O_Y5hLzl7Jwz1lwg521ZFYxXBZeKF9UzsuFtLYtS1uI52TAmeMFFXZ2QV4h3jEkl6_IlORF1U4pKlhvy5zZCmCGa5O-B2iXeA9LQ0T6CSRDpaPrJp8UBPf3QsIff76mfqHFhALQwJeqdD7NJe28p2jD4gB6piUANYrA-Mxz96dM-j9mMxHzEJfbemoHaMM4D_PLpcEb3vt9nOxswrfZPmrS-Y1ydzOSooQ4Gc8iQCGmJE02Bdstkkw_Ta_KiMwPCm8d1S75ff_x29bm4-frpy9XlTWFlWaZCsp1qhLS8qyrZKdEaUEK2NW-anJRiogKpwCnWsl1Xtc5IZQA6JV3eAgi5JadH7hzDjwUw6dHnLIbBTBAW1LxpcxdCZfyW8KPUxoAYodNz9KOJB82ZXhvUxwZ1blCvDep15t0jftmN4J4m_lWWBeIowHw19RD1XchR5C__h_oX3L-r1A</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Tarrant, R. C.</creator><creator>Queally, J. M.</creator><creator>O’Loughlin, P. F.</creator><creator>Sheeran, P.</creator><creator>Moore, D. P.</creator><creator>Kiely, P. J.</creator><general>Springer London</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>Preoperative curves of greater magnitude (&gt;70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function</title><author>Tarrant, R. C. ; Queally, J. M. ; O’Loughlin, P. F. ; Sheeran, P. ; Moore, D. P. ; Kiely, P. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-30b9723c1f553f928ae923861771269025e39ed9080bf58da39aeef93dda3ee23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Blood Loss, Surgical</topic><topic>Blood Transfusion</topic><topic>Family Medicine</topic><topic>Female</topic><topic>General Practice</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine &amp; Public Health</topic><topic>Original Article</topic><topic>Prospective Studies</topic><topic>Scoliosis - surgery</topic><topic>Spinal Fusion - methods</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tarrant, R. C.</creatorcontrib><creatorcontrib>Queally, J. M.</creatorcontrib><creatorcontrib>O’Loughlin, P. F.</creatorcontrib><creatorcontrib>Sheeran, P.</creatorcontrib><creatorcontrib>Moore, D. P.</creatorcontrib><creatorcontrib>Kiely, P. J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Irish journal of medical science</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tarrant, R. C.</au><au>Queally, J. M.</au><au>O’Loughlin, P. F.</au><au>Sheeran, P.</au><au>Moore, D. P.</au><au>Kiely, P. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative curves of greater magnitude (&gt;70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function</atitle><jtitle>Irish journal of medical science</jtitle><stitle>Ir J Med Sci</stitle><addtitle>Ir J Med Sci</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>185</volume><issue>2</issue><spage>463</spage><epage>471</epage><pages>463-471</pages><issn>0021-1265</issn><eissn>1863-4362</eissn><abstract>Background Surgical procedures to correct larger curve magnitudes &gt;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 &gt;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 &gt;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 &gt;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 &gt;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  &lt; 0.0001). Conclusion Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70° vs. those ≤70°. Surgical correction for curves &gt;70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.</abstract><cop>London</cop><pub>Springer London</pub><pmid>26742534</pmid><doi>10.1007/s11845-015-1391-5</doi><tpages>9</tpages></addata></record>
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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
title 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
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