Syndromic Scoliosis: National Trends in Surgical Management and Inpatient Hospital Outcomes: A 12-Year Analysis.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Nov 2019
15 Nov 2019
Historique:
entrez:
6
11
2019
pubmed:
7
11
2019
medline:
29
1
2020
Statut:
ppublish
Résumé
Retrospective cohort study. Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction. Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction. The Kids' Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed. An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span. Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort study.
OBJECTIVE
OBJECTIVE
Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction.
METHODS
METHODS
The Kids' Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed.
RESULTS
RESULTS
An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span.
CONCLUSION
CONCLUSIONS
Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 31689252
doi: 10.1097/BRS.0000000000003134
pii: 00007632-201911150-00009
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1564-1570Références
Theologis AA, Sing DC, Chekeni F, et al. National trends in the surgical management of adolescent idiopathic scoliosis: analysis of a National Estimate of 60,108 children from the National Inpatient Sample over a 13-year time period in the United States. Spine Deform 2017; 5:56–65.
Rumalla K, Yarbrough CK, Pugely AJ, et al. Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine 2016; 25:500–508.
Levy BJ, Schulz JF, Fornari ED, et al. Complications associated with surgical repair of syndromic scoliosis. Scoliosis 2015; 10:14.
Milbrandt TA, Johnston CE. Down syndrome and scoliosis: a review of a 50-year experience at one institution. Spine (Phila Pa 1976) 2005; 30:2051–2055.
Lerman JA, Emans JB, Hall JE, et al. Spinal arthrodesis for scoliosis in Down syndrome. J Pediatr Orthop 2003; 23:159–161.
World Health Organization, Practice Management Information Corporation. ICD-9-CM: International classification of diseases, 9th revision: Clinical modification. Vol 1. PMIC (Practice Management Information Corporation); 1998.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–383.
Ondeck NT, Bohl DD, Bovonratwet P, et al. Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: a comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index. Spine J 2018; 18:44–52.
HCUP clinical classifications software (CCS) for ICD-9-CM. healthcare cost and utilization project (HCUP). 2002-2012. Agency for healthcare research and quality, rockville, MD. Available at: www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed April 1, 2018.
De la Garza Ramos R, Goodwin CR, Abu-Bonsrah N, et al. Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample. J Neurosurg Pediatr 2016; 25:730–736.
Sharma S, Wu C, Andersen T, et al. Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 2013; 22:1230–1249.
Gjolaj JP, Sponseller PD, Shah SA, et al. Spinal deformity correction in Marfan syndrome versus adolescent idiopathic scoliosis: learning from the differences. Spine (Phila Pa 1976) 2012; 37:1558–1565.
Shirley ED, Ain MC. Achondroplasia: manifestations and treatment. J Am Acad Orthop Surg 2009; 17:231–241.
Meert KL, Kannan S, Mooney JF. Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine (Phila Pa 1976) 2002; 27:2137–2142.
Shapiro F, Zurakowski D, Sethna NF. Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine (Phila Pa 1976) 2007; 32:2278–2283.
Hassan N, Halanski M, Wincek J, et al. Blood management in pediatric spinal deformity surgery: review of a 2-year experience. Transfusion 2011; 51:2133–2141.
Gologorsky Y, Knightly JJ, Chi JH, et al. The Nationwide Inpatient Sample database does not accurately reflect surgical indications for fusion. J Neurosurg Spine 2014; 21:984–993.
Golinvaux NS, Bohl DD, Basques BA, et al. Administrative database concerns: accuracy of International Classification of Diseases, Ninth Revision coding is poor for preoperative anemia in patients undergoing spinal fusion. Spine (Phila Pa 1976) 2014; 39:2019–2023.
Bohl DD, Russo GS, Basques BA, et al. Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures. J Bone Joint Surg Am 2014; 96:e193.