Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20, 346 patients

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Adolescent idiopathic scoliosis (AIS) can cause substantial morbidity and may require surgical intervention. In this study, the authors aimed to evaluate US trends in operative AIS as well as patient comorbidities, operative approach, in-hospital complications, hospital length of stay (LOS), and hospital charges in the US for the period from 1997 to 2012.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Patients with AIS (ICD-9-CM diagnosis codes 737.30) who had undergone spinal fusion (ICD-9-CM procedure codes 81.xx) from 1997 to 2012 were identified from the Kids' Inpatient Database. Parameters of interest included patient comorbidities, operative approach (posterior, anterior, or combined anteroposterior), in-hospital complications, hospital LOS, and hospital charges.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The authors identified 20, 346 patients in the age range of 0–21 years who had been admitted for AIS surgery in the defined study period. Posterior fusions composed 63.4% of procedures in 1997 and 94.1% in 2012 (r = 0.95, p &lt; 0.01). The mean number of comorbidities among all fusion groups increased from 3.0 in 1997 to 4.2 in 2012 (r = 0.92, p = 0.01). The percentage of patients with complications increased from 15.6% in 1997 to 22.3% in 2012 (r = 0.78, p = 0.07). The average hospital LOS decreased from 6.5 days in 1997 to 5.6 days in 2012 (r = -0.86, p = 0.03). From 1997 to 2012, the mean hospital charges (adjusted to 2012 US dollars) for surgical treatment of AIS more than tripled from $55,495 in 1997 to $177,176 in 2012 (r = 0.99, p &lt; 0.01).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Over the 15-year period considered in this study, there was an increasing trend toward using posterior-based techniques for AIS corrective surgery. The number of comorbid conditions per patient and thus the medical complexity of patients treated for AIS have increased. The mean charges for the treatment of AIS have increased, with a national bill over $1.1 billion per year in 2012.</jats:p></jats:sec>

Rapidly increasing incidence in scoliosis surgery over 14 years in a nationwide sample

“…These results mirror findings from other large population-based research demonstrating significant reductions in hospital LOS [7,8,17,20]. Vigneswaran et al in a study of surgical outcomes in individuals with idiopathic scoliosis, reported a decrease in average hospital LOS from 6.5 days in 1997 to 5.6 days in 2012 [8], which does not seem to be associated with higher complication rates [21].…”

“…This trend was also found in the US among adolescents undergoing surgery for scoliosis [7,8]. Vigneswaran et al in a study of 20,346 adolescents with scoliosis aged 0-12 years, found posterior fusions increased from 63.4% in 1997 to 94.1% in 2012 [8].…”

“…This trend was also found in the US among adolescents undergoing surgery for scoliosis [7,8]. Vigneswaran et al in a study of 20,346 adolescents with scoliosis aged 0-12 years, found posterior fusions increased from 63.4% in 1997 to 94.1% in 2012 [8]. The shift in surgical approach away from anterior fusions may be attributed to the re-popularization of the posterior approach and the increased pulmonary function described after posterior surgery compared to anterior surgery [22].…”

“…There is also limited information on trends in length of stay [7,8]. This study will examine data on patients surgically treated for scoliosis in Sweden between 2000 and 2013 and aims to answer the following questions: 1) What is the true incidence and change in incidence of surgically treated scoliosis among Swedish individuals (ages 0-21 years), what are the diagnoses, and in which age groups is surgery performed?…”

Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis—a single‐center experience of patient blood management in 210 cases

“…Bleeding in major surgery often necessitates the transfusion of allogeneic red blood cells (RBCs), which is associated with an increased risk of infection and alloimmunization as well as hemolytic, febrile, and allergic reactions . In patients with adolescent idiopathic scoliosis (AIS), surgical treatment involves a posterior approach with multisegmental pedicle screw fixation . Although this procedure is generally considered safe with few surgical complications, there are considerable variations in fusion length, surgical time, and the extent of soft‐tissue exposure .…”