Continued Increase in Cost of Care Despite Decrease in Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Shaw, K. Aaron; Ange, Brittany; Varghese, George; Murphy, Joshua; Fletcher, Nicholas D.

doi:10.5435/jaaosglobal-d-21-00192

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…11,13 Moreover, these surgeries can cost patients upwards of $200,000, and account for more than $1.1 billion annual collective healthcare spending in the United States alone. [14][15][16][17] While the costs of TLSOs vary, even the most expensive (custom-made) braces typically cost less than $5,000, with lifetime costs of bracing treatment estimated to be less than $65,000, or roughly a third of the cost of surgery. [18][19][20] Avoiding spinal fusion by early AIS identification and appropriate treatment with a TLSO brace is advantageous to both the patient and healthcare systems.…”

Section: Key Conceptsmentioning

confidence: 99%

Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

Erkkila¹,

Reynolds²,

Weissman³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Background: Adolescent idiopathic scoliosis (AIS) is a common referral to pediatric orthopaedic surgeons. Timely treatment with appropriate bracing decreases the risk of curve progression and need for surgical intervention. Despite pediatrician screening, patients still present to orthopaedic surgeons with curve magnitudes too significant for appropriate nonoperative bracing. Methods: This retrospective cross-sectional study included patients aged 10 to 18 years diagnosed with AIS between 2011-2021 at a major metropolitan tertiary care center. Patients were excluded if initial radiographs were obtained more than 1 week after clinical diagnosis. Scoliosis severity was classified based on initial radiographs. Sociodemographic factors were recorded, including patient addresses, which were cross-referenced with the diversitydatakids.org Child Opportunity Index (COI) database, which analyzes the quality of resources in a geographic area. Results: Gender, health insurance provider, race/ethnicity, and COI were all found to have a statistically significant relationship with CA and age at initial presentation. The odds of presenting with severe (versus mild and moderate) scoliosis was 2.3 times higher for patients who identified as black/African American compared to those who identified as white. Additionally, the odds of initially presenting with severe scoliosis were almost 40% higher in females compared to males. Furthermore, each stepwise increase in COI was associated with a 17%-19% decrease in odds of presenting with severe scoliosis, depending on standardization. Conclusions: There are sociodemographic disparities in the identification and initiation of treatment for AIS. Specifically, the odds of presenting with severe scoliosis are increased in patients who identify as black/African American or female and/or come from areas with lower access to resources (as defined by COI). Appropriate and timely referral to a pediatric orthopaedic surgeon for AIS treatment thus requires 1) educating primary care providers, pediatricians, and scoliosis screeners on how to appropriately identify scoliosis and the risks associated with late identification/referral and 2) public health initiatives to address access to care for patients at risk for late scoliosis identification.

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Section: Key Conceptsmentioning

confidence: 99%

Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

Erkkila¹,

Reynolds²,

Weissman³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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New Surgical Approaches to Scoliosis Repair in Pediatric Patients—Implications for Anesthetic Management

Ferschl,

Shibata,

Wong

2024

Curr Anesthesiol Rep

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Purpose of Review The treatment of pediatric scoliosis has evolved over time. Newer treatment modalities provide alternative options for patients that optimize outcomes. In this manuscript, we will review pediatric scoliosis and focus on the anesthetic management techniques for its surgical correction. Recent Findings Many modifications to the surgical repair of scoliosis have occurred since the procedure was first performed in the 1960s. Improved surgical equipment and imaging techniques have improved outcomes for posterior spinal fusion. Many centers are now employing anterior spinal tethering procedures. In all cases, anesthetic techniques have been refined over time to improve pre-, intra-, and post-operative management. Summary Innovative surgical approaches and novel anesthetic protocols have impacted the management of patients with scoliosis. Future research is needed to further refine techniques.

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Continued Increase in Cost of Care Despite Decrease in Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Cited by 2 publications

References 31 publications

Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

Factors Associated with Presentation of Severe Adolescent Idiopathic Scoliosis

New Surgical Approaches to Scoliosis Repair in Pediatric Patients—Implications for Anesthetic Management

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