Background ContextCorrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature. PurposeTo identify predictors of gain in spinal height following corrective surgery for AIS. We present a unique model to predict height gain prior to intervention, which could contribute to the preoperative counselling and consenting process. Study DesignThis was a retrospective case series. All surgeries were performed by one of four substantive paediatric spinal surgeons within a single regional centre over a three-and-a-half year period.Patient Sample 104 patients who had instrumented posterior spinal fusion for AIS were included. There were 93 females and the age range was 11 to 17 years. All patients had posterior instrumented fusion using rods and anchors (pedicle screws +/-hooks).Outcome Measures Postoperative spinal height was the primary outcome measure. SH (C7 to L5) and Cobb angles were measured from a pre-and-postoperative standing X-ray of each patient. MethodsVariables associated with patients (demographic and radiological) and the surgical constructs were analysed for predictability of height gain. A model was derived including only significant predictors of substantive importance using hierarchical regression methods.Cross-validation procedures verified the adequacy of the model fit. Analysis was performed using SPSS version 20.0. ResultsThe major curve was thoracic in 90% of cases. The number of vertebrae fused ranged from 5 to 15. T (SD 2.13 cm). The model presented included preoperative height, preoperative Cobb angle and number of vertebrae within the construct, with coefficients of 1.00 (95% CI: 0.90, 1.09), 0.067 (95% CI: 0.039, 0.095), and 0.26 (95% CI: 0.11, 0.41) respectively. This model had an adjusted-R2value of 0.83 and a R2 for prediction of 0.79; and can be shown to have similar predictive capability as a model comprising a wider range of predictors. ConclusionsThe greatest postoperative height values following posterior spinal fusion for AIS could be expected from a patient with greater preoperative height and Cobb angle, and whose construct spans a large number of vertebrae. Many thanks for giving us the further opportunity to revise our manuscript. We have revised the manuscript in the hope of addressing the outstanding concerns. We hope that you find this revision suitable for publication in The Spine Journal. We remain happy to address any further suggestions.We have copied the review comments and responded (in red text) to each:1. Please limit all significant digits following the decimal to two in the text and tables. The only exception can be p-values up to 0.001 and then <0.001 as indicated. We have applied this throughout.2. The residuals plot is unnecessary and can be removed from a revised work. The plot itself has been removed.3. The results and discussion are still overly technical for this clinical journal. Please f...
Background contextPrevious studies have shown that modern
The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.
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