Our study revealed an association between a number of psychosocial factors and QoL among patients with DM in Ghana and Nigeria.

Study Design: Retrospective review of consecutive series. Objectives: This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. Methods: Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. Results: The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m2, P = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, P = .87.), coronal Cobb angle (95° vs 88.5°, P = .43), preoperative forced vital capacity (45.3% vs 62.0%, P = .02), preoperative FEV1 (forced expiratory volume in 1 second) (41.9% vs 63.1%, P < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV1 (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, P = .013). Conclusion: The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV1 was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.

Background Pulmonary complications are important cause of morbidity and mortality in patients following spinal surgeries. There is paucity of literature on pulmonary complications following complex spine deformity surgery in underserved regions. This study sought to assess the incidence and risk factors of pulmonary complication following complex spine deformity surgery Methods Data of 276 complex spine deformity patients aged 3-25yrs who were consecutively treated at a single site were retrospectively reviewed. Data was analyzed using Stata 14 software. Patients were labelled into two groups: Grp 1: patients with pulmonary complications(N=17) vs Grp 2: patients with no pulmonary complications (N=259). Comparative analysis for risk factors included independent t-test and chi square test for independence. Multivariate logistic regression analysis was also performed. Results The incidence proportion of pulmonary complication was 17/276 (6.1%) (Grp 1) whiles 259 pts had no pulmonary events (Grp 2). There were 8M/9F for Grp 1 vs 100M/159F Grp 2, p=0.48. BMI was similar in both groups (17.2 vs 18.4km -2 , p=0.15). Average pre-op sagittal cobb (90.6 vs 88.7deg, p=0.87.), coronal cobb (95 vs 88.5deg, p=0.43), Pre-Op FVC (45.3 vs 62.0%, p=0.02), Pre-Op FEV1 (41.9% vs 63.1, p<0.001), Grp 1 vs Grp 2, respectively. EBL, OR time and Surgery Levels were similar in both Grps. Thoracoplasty was performed in 41.18% vs 21.57%, p=0.06, SPO 47.06% vs 42.31%, p=0.04 and VCR 5.88% vs 20.31%, p=0.145, Grp 1 vs Grp 2, respectively. Multivariate logistic regression showed that every unit increase in pre-Op FVC (%) decreases the odds of pulmonary complication by 5% (OR=0.95, 95% CI 0.90 to 0.99, p=0.045). Conclusion The observed 6.1% incidence of pulmonary complications is comparable to reported series. Only pre-Op FVC was an independent predictor of pulmonary complications. The observed case fatality rate (17%) following pulmonary complications highlights the need for thorough preoperative evaluation to identify high risk patients. Key words: Complex spine deformity; Pulmonary complications; late presentation; Forced Vital Capacity; Halo Gravity Traction; FVC; pediatric deformity; scoliosis; Pulmonary function tests; PFT; complications; Preoperative management.

Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in GhanaPatients: Seventy-six patients who underwent complex spine deformity surgeryInterventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications.Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Blood loss (ml) of patients in groups 1 and 2 were 1583ml± 830.48 vs 1623ml ± 681.34, p=0.82, respectively. The rate of allogeneic blood transfusion in groups 1 and 2 were 71% vs 80.65%, p=0.88, respectively. Haemoglobin levels (g/dL) in groups 1 and 2 were comparable in both groups at Post-operative Day (POD) 0 and POD 1. Incidence of minor allogeneic transfusion reaction was 1/45 vs 1/31, p=0.80, group-1 and group-2, respectively.Conclusion: Acute normovolaemic haemodilution can be safely performed in complex spine surgery in underserved regions. However, its use does not obviate allogeneic transfusion in patients with complex spine deformities in whom large volumes of blood loss is expected.