Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? A prospective propensity matching score analysis

Kwan, Mun Keong; Chan, Chris Yin Wei

doi:10.1016/j.spinee.2016.09.005

Cited by 37 publications

(44 citation statements)

References 28 publications

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“…In our research, the blood transfusion rate in cases with idiopathic scoliosis was 17.2% (64/372). Our findings were almost the same except for two surgical strategies, which might lead to a faster surgery, reduced intraoperative blood loss, and a reduced risk of ABT [10,11].…”

Section: Discussionsupporting

confidence: 60%

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Dong

Tang

Wang

et al. 2021

BMC Musculoskelet Disord

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Background To assess the risk factors for blood transfusion in a great number of adolescent cases with different types of scoliosis who received scoliosis surgery. Methods Data of patients who were diagnosed as scoliosis and received one-stage posterior correction and spinal fusion from January 2014 to December 2017 were prospectively collected and retrospectively analyzed. Patients’ demographic characteristics, segments of spinal fusion, Cobb angle of the major curve,osteotomy pattern, preoperative and postoperative levels of hemoglobin, and allogeneic blood transfusion (ABT) were recorded and analyzed. Results In this study, 722 cases with adolescent scoliosis were included, of whom 32.8% (237/722) received ABT. Risk factors included diagnosis: neurofibromatosis (OR = 5.592), syndromic (OR = 3.029),osteotomy: Ponte osteotomy (OR = 5.997), hemivertebrae resection (OR = 29.171), pedicle subtraction osteotomy (PSO)(OR = 8.712), vertebral column resection (VCR)(OR = 32.265);fusion segments (OR = 1.224) and intraoperative blood loss (OR = 1.004). In the subgroup analysis of cases with idiopathic scoliosis, Ponte osteotomy (OR = 6.086), length of segments of spinal fusion (OR = 1.293), and intraoperative blood loss (OR = 1.001) were found as risk factors for ABT. Results of receiver operating characteristic (ROC) curve analysis revealed that length of segments of spinal fusion equal to 11.5 vertebrae was the best cutoff value for cases with idiopathic scoliosis who did not receive osteotomy in both ABT group and non-ABT group. In the subgroup analysis of congenital scoliosis, Ponte osteotomy (OR = 5.087), hemivertebra resection (OR = 5.457), PSO (OR = 4.055), VCR (OR = 6.940), and intraoperative blood loss (OR = 1.004) were risk factors for ABT. Conclusions Method of diagnosis, osteotomy pattern, segments of spinal fusion, and intraoperative blood loss were risk factors for ABT in cases with adolescent scoliosis. In cases with idiopathic scoliosis, Ponte osteotomy and segments of spinal fusion longer than 11.5 vertebrae were risk factors for ABT. In cases with congenital scoliosis, osteotomy pattern was the main risk factor for ABT. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 60%

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Dong

Tang

Wang

et al. 2021

BMC Musculoskelet Disord

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“…[ 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. [ 13 ] Our study also demonstrated decreased operative time with 2 attending surgeons in SEMLS.…”

Section: Discussionmentioning

confidence: 99%

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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“…A study was done by Kwan MK et al to compare surgery outcomes between a single versus a dual attending surgeon strategy. Their result showed that those who were operated by two surgeons had shorter operating time 164 min (257.3 min with a single surgeon), less blood loss 893.7 ml (1254.7 ml with a single surgeon) and shorter length of stay 3.4 days [14] . Compared to our data, the blood loss in our study is minimal with a very comparable single surgeon operative time.…”

Section: Discussionmentioning

confidence: 99%

Scoliosis surgery, predictors and outcomes in a tertiary care hospital, Riyadh, KSA

Almalki¹,

Alanazi²,

Babiker³

et al. 2017

Int. J. Orthop. Sci.

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Background: Scoliosis is a back deformity, defined as structural lateral curvature of spine more than 10° (cobb angle) with rotation. Surgical intervention has better radiographic and clinical outcomes for the patients. However, it's not indicated in all cases and it's associated with certain complications. Methods: This is case series study which tracked subjects with scoliosis surgery. We investigated the data of all scoliosis surgery cases in our institution from 2009 to 2016 with internal board review approval. A data collection form was used to extract the data from the charts which included some demographic data such as age, gender, and date of birth, and indication of the procedure were included. Perioperative data such as operative time, blood loss, and perioperative death were estimated. Also, postoperative complications were included. Length of stay in hospital was calculated. Preoperative and postoperative recorded x-rays were interpreted and recorded. All of the reviewed data were coded and expelled into Excel sheet. Statistical package for social sciences (SPSS) version 22 was used for data analysis. Categorical variables were described by frequencies and percentages. Unpaired t-test was used to compare the pre and post-operative outcomes. Results: The mean age for the patients' who underwent the surgery is 17.7 (range, 8-56 years). 39% (32) of the sample is male and 61% (50) is female. The mean blood loss was 482.3 mL (range, 200-2900 mL) with the mean days of stay in hospital was 10 days (range, 4-90 days). The mean operative time was 250 minutes (range, 130-360 minutes). The most common indications for the surgery where neuromuscular scoliosis 36 (43.9%), idiopathic scoliosis 32 (39%). The mean cobb angel was 65° (range, 40°-116°) preoperatively and cobb angel of 16.1° (range, 0-87°) (P<0.001) postoperatively. Conclusion: Scoliosis surgery are effictive method of correcting different types of scolisos and are associated with minimal complications.

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Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? A prospective propensity matching score analysis

Cited by 37 publications

References 28 publications

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

Single-event multilevel surgery in cerebral palsy

Scoliosis surgery, predictors and outcomes in a tertiary care hospital, Riyadh, KSA

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