Perioperative Outcome in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Chan, Chris Yin Wei; Kwan, Mun Keong

doi:10.1097/brs.0000000000001349

Cited by 47 publications

(42 citation statements)

References 27 publications

(26 reference statements)

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“…The framework introduced here promises a surgical decision-making tool that can be personalized for physicians based on their preferred techniques. The rod length and curvature (using the EP clusters) can be determined prior to surgery to reduce the operation room time and number of staff which in turns reduces the surgical cost as well as blood loss and risk of infection 44 , 50 , 51 . Moreover, as the patients’ expectation plays an important role in their satisfaction, self-image, and quality of life after surgery 52 – 54 , by exploring the possible outcomes, a more comprehensive expectation of the surgical outcomes can be achieved by the patient, patient’s family, and their surgeon as they go through the process of surgery.…”

Section: Discussionmentioning

confidence: 99%

Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction

Pasha

Flynn

2018

Sci Rep

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Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) deformity of the spinal column. For progressive deformities in AIS, the spinal fusion surgery aims to correct and stabilize the deformity; however, common surgical planning approaches based on the 2D X-rays and subjective surgical decision-making have been challenged by poor clinical outcomes. As the suboptimal surgical outcomes can significantly impact the cost, risk of revision surgery, and long-term rehabilitation of adolescent patients, objective patient-specific models that predict the outcome of different treatment scenarios are in high demand. 3D classification of the spinal curvature and identifying the key surgical parameters influencing the outcomes are required for such models. Here, we show that K-means clustering of the isotropically scaled 3D spinal curves provides an effective, data-driven method for classification of patients. We further propose, and evaluate in 67 right thoracic AIS patients, that by knowing the patients’ pre-operative and early post-operation clusters and the vertebral levels which were instrumented during the surgery, the two-year outcome cluster can be determined. This framework, once applied to a larger heterogeneous patient dataset, can further isolate the key surgeon-modifiable parameters and eventually lead to a patient-specific predictive model based on a limited number of factors determinable prior to surgery.

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Section: Discussionmentioning

confidence: 99%

Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction

Pasha

Flynn

2018

Sci Rep

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“…[ 12 ] In another prospective study of patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion, Chan and Kwan found that surgery performed by 2 surgeons results in decreased operative time, blood loss, postoperative morphine usage, and hospital length of stay compared with single surgeon teams. [ 14 ] These results were mirrored in subgroups of patients with Lenke 1 and 2 curves. [ 15 , 16 ] Similarly, Abousamra et al found decreased operative time and blood loss in spine surgery performed by 2 attending surgeons as compared with a single surgeon in patients with CP.…”

Section: Discussionmentioning

confidence: 90%

Single-event multilevel surgery in cerebral palsy

et al. 2021

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The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons. A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared. In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons ( P = 0.03). Decreased operative time was associated with an estimated savings of $2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P = 0.11). Decreased operative time was associated with an estimated savings of $1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS. Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP. Level of Evidence: Level III

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“…Fifty-five retrospective studies, nine prospective studies, and three randomized controlled trials were included. There were 17 multi-center studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Resultsmentioning

confidence: 99%

Operative time in adolescent idiopathic scoliosis surgery: a need for a standard definition

Wagala

Marasigan

Mian

et al. 2020

Journal of Pediatric Orthopaedics B

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Our objective is to report and define 'operative time' in adolescent idiopathic scoliosis (AIS) posterior spinal fusion surgeries. Documenting key times during surgery are important to compare operative risks, assess learning curves, and evaluate team efficiency in AIS surgery. 'Operative time' in literature has not been standardized. Systematic review was performed by two reviewers. Keywords included operative time, duration of surgery, and scoliosis. One thousand nine hundred six studies were identified, 1092 duplicates were removed and 670 abstracts were excluded. Of the 144 articles, 67 met inclusion and exclusion criteria. Studies were evaluated for number of patients, operative time, and definition of operative time. Meta-analysis was not performed due to confounders. Of the 67 studies (6678 patients), only 14 (1565 patients) defined operative time, and all specified as incision to closure. From these 14 studies, the median operative time was 248 minutes (range 174-448 minutes). In the 53 studies (5113 patients) without a definition, one study reported time in a non-comparable format, therefore, data were analyzed for 52 studies (5078 patients) with a median operative time of 252 minutes (wider range 139-523 minutes). A clear standardized definition of operative or surgical time in spine surgery does not exist. We believe that operative time should be clearly described for each published study for accurate documentation and be defined from incision time to spine dressing completion time in order to standardize study results. Level of evidence: IV.

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Perioperative Outcome in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Abstract: 2.

Cited by 47 publications

References 27 publications

Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction

Data-driven Classification of the 3D Spinal Curve in Adolescent Idiopathic Scoliosis with an Applications in Surgical Outcome Prediction

Single-event multilevel surgery in cerebral palsy

Operative time in adolescent idiopathic scoliosis surgery: a need for a standard definition

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