Abstract
Introduction
Surgical procedures to correct larger curve magnitudes >70°in patients with adolescent idiopathic scoliosis (AIS) are still common globally. Despite the increased complexity associated with surgical correction of these curves, there is limited evidence available assessing the effect of preoperative curve severity on clinical or economical outcomes. This study aimed to examine the impact of preoperative curves >70° versus those ≤ 70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF).
Material and Methods
Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to postoperative function was reported. Preoperative curves > 70° versus ≤ 70°, were analyzed 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 greater than 70°, identified in 21 patients (27.3%), were associated with significantly longer surgical duration (median 6.5 hour versus 5 hour, p = 0.001) and increased blood loss (median 1,250ml versus 1,000ml, p = 0.005) – these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, Confidence Interval 1.4–2.7, p = 0.004). Curves greater than 70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 versus €28,620, P < 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°versus those ≤ 70°. Surgical correction for curves > 70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.