Usage of Chewing Gum in Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis

Chan, Chris Yin Wei; Chiu, Chee Kidd; Lee, Chee Kean; Gani, Siti Mariam Abd; Mohamad, Siti Mariam; Hasan, Mohd Shahnaz; Kwan, Mun Keong

doi:10.1097/brs.0000000000002135

Cited by 14 publications

(12 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the goal of blood loss minimization during spine surgery, we have concentrated our efforts toward developing a series of strategies that have resulted in nearly eliminating the need for blood transfusion. In contrast to some of the more recently published data regarding blood loss in surgery for AIS (Table 1) [13][14][15][16][17][18][19][20][21][22] our experience shows that blood transfusion was utilized in only one patient of a consecutive series of 130 cases of patients undergoing typical instrumented posterior fusion utilizing multiple pedicle screws and dual rod fixation. We conclude that the methods employed in both the surgical management and the anesthetic management of these patients had combined to allow this surgery to be performed with extremely low blood loss without any detectable adverse effects on the patient.…”

Section: Discussioncontrasting

confidence: 78%

See 1 more Smart Citation

Value in Scoliosis Surgery

Stanton

Grauer

et al. 2021

Spine

View full text Add to dashboard Cite

Study Design. Retrospective chart review.Objective. The aim of this study was to document the impact of coordinated surgical and anesthetic techniques on estimated blood loss (EBL) and subsequent need for transfusion. Summary of Background Data. Scoliosis surgery is typically associated with large quantities of blood loss, and consequently blood transfusion may be necessary. Many strategies have been employed to minimize blood loss, including blood collection with reinfusion (''cell-saver'') and the use of antifibrinolytic drugs. We reviewed our experience with methods to minimize blood loss to show that transfusion should be a rare event. Methods. One hundred and thirty consecutive cases of spine fusion for adolescent idiopathic scoliosis utilizing pedicle screw fixation were reviewed from March 2013 to October 2019. The senior author was the primary surgeon for all cases. Data were collected from the electronic medical record, including age, sex, weight, number of instrumented levels, EBL, total fluids administered during surgery, pre-and postoperative hemoglobin, and procedure duration. Results. The average EBL was 232 AE 152 mL (range 37-740 mL). The average preoperative hemoglobin was 13.4 AE 1.2 g/dL and the average postoperative hemoglobin (last measured before discharge) was 9.0 AE 1.2 g/dL. One patient received a transfusion of 270 mL homologous blood. Blood salvage and reinfusion (''cell-saver'') was not used. No patient was managed with antifibrinolytic drugs. Conclusion.Minimizing blood loss using a combination of surgical and anesthesia techniques can effectively eliminate the need for blood transfusion. The elimination of costly adjuncts increases the value of a complex orthopedic procedure.

show abstract

Section: Discussioncontrasting

confidence: 78%

“…Spinal fusion for adolescent idiopathic scoliosis (AIS) is typically associated with high blood loss 1–22 . As a consequence, there are a number of articles proposing a variety of strategies to help minimize blood loss and the subsequent need for blood transfusion in scoliosis surgery.…”

mentioning

confidence: 99%

Value in Scoliosis Surgery

Stanton

Grauer

et al. 2021

Spine

View full text Add to dashboard Cite

show abstract

“…Needs to Explore an Effective Protocol for Prevent POI According to previous studies, preventive measures for POI include the early introduction of oral nutrition, early mobilization, use of coffee and chewing gum, [33][34][35][36][37][38] and treatments including appropriate fasting and intravenous fluid resuscitation, prokinetic agents, pantothenic acid, μ-receptor antagonist, and nasogastric decompression. 22,[39][40][41] However, the efficacy of these procedures remains controversial, and there is still a lack of a standardized protocol.…”

Section: The Association Between Sagittal Height Correction and Poimentioning

confidence: 99%

Incidence and Risk Factors for Postoperative Ileus after Posterior Surgery in Adolescent Idiopathic Scoliosis

Zhang

et al. 2023

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective Postoperative ileus (POI) is a relatively common complication after spinal fusion surgery, which can lead to delayed recovery, prolonged length of stay and increased medical costs. However, little is known about the incidence and risk factors of POI after corrective surgery for patients with adolescent idiopathic scoliosis (AIS). This study was performed to report the incidence of POI and identify the independent risk factors for POI after postoperative corrective surgery. Methods In this retrospective cohort study, A total of 318 patients with AIS who underwent corrective surgery from April 2015 to February 2021 were enrolled and divided into two groups: those with POI and those without POI. The Student's t test, Mann–Whitney U test, and Pearson's chi‐square test were used to compare the two groups regarding patient demographics and preoperative characteristics (age, sex and the major curve type), intraoperative and postoperative parameters (lowest instrumented vertebra [LIV], number of screws, and length of stay), radiographic parameters (T5–12 thoracic kyphosis [TK], T10–L2 thoracolumbar kyphosis and height [TLK and T10–L2 height], L1–S1 lumbar lordosis [LL], and L1–5 height). Then, a multivariate logistic regression analysis was used to identify independent risk factors for POI, and a receiver operating characteristic (ROC) curve was performed to assess the predictive values of these risk factors. Results Forty‐two (13.2%) of 318 patients who developed POI following corrective surgery were identified. The group with POI had a significantly longer length of stay, more lumbar screws, higher proportions of a major lumbar curve and lumbar anterior screw breech, and a lower LIV. Among radiographic parameters, the mean lumbar Cobb angle at baseline, the changes in the lumbar Cobb angle, and T10–L2 and L1–5 height from before to after surgery were significantly larger in the group with POI than in the group without POI. Multivariate logistic regression analysis showed that large changes in T10–L2 (odds ratio [OR] =2.846, P = 0.007) and L1–5 height (OR = 31.294, p = 0.000) and lumbar anterior screw breech (OR = 5.561, P = 0.006) were independent risk factors for POI. The cutoff values for the changes in T10–L2 and L1–5 height were 1.885 cm and 1.195 cm, respectively. Conclusion In this study, we identified that large changes in T10–L2 and L1–5 height and lumbar anterior screw breech were independent risk factors for POI after corrective surgery. Improving the accuracy of pedicle screw placement might reduce the incidence of POI, and greater attention should be given to patients who are likely to have large changes in T10–L2 and L1–5 height after corrective surgery.

show abstract

“…In terms of prevention, few studies assessing prophylactic medications showed their administration post-operatively to be inefficient in preventing post-operative ileus. 6 - 8 Analysis of risk factors found thoraco-lumbar fusion surgery, longer surgeries, higher intra-operative blood loss and higher postoperative morphine doses to be associated with post-operative ileus. 9 Nonetheless, given the clinical and economic significance of post-operative ileus, a more extensive risk factor analysis specifically to spine surgeries is still lacking.…”

Section: Introductionmentioning

confidence: 99%

What Are Risk Factors for an Ileus After Posterior Spine Surgery?—A Case Control Study

Yılmaz

Benca

Patel

et al. 2021

Global Spine Journal

View full text Add to dashboard Cite

Study design: Case-Control Study. Objective: The purpose of this retrospective study is to evaluate risk factors for developing a postoperative ileus after posterior spine surgery. Methods: Patient charts, including radiographs were evaluated retrospectively. Diagnosis of an ileus was confirmed radiographically by a CT scan in all cases. The control group was retrieved by selecting a random sample of patients undergoing posterior spine surgery who did not develop bowel dysfunction postoperatively. Results: A total of 40 patients had a postoperative ileus. The control group consisted of 80 patients. Both groups did not differ significantly in age, gender, BMI, tobacco use, comorbidities or status of previous abdominal surgery. Significant differences between the 2 groups was the length of stay (5.9 vs. 11.2; p = 0.001), surgery in the lumbar spine (47.5% vs. 87.5%; p < 0.001) and major spine surgery involving > 3 levels (35.0% vs. 57.5%; p = 0.019). Patients who suffered from an ileus were more likely to be treated in ICU (23.8% vs. 37.5%; p = 0.115), being re-admitted (0.0% vs 5.0%; p = 0.044) and having a delayed discharge (32.5% vs. 57.5%; p = 0.009). Multivariable analysis demonstrated that lumbar spine surgery compared to thoracic and/or cervical spine surgery (p = 0.00, OR 8.7 CI 2.9-25.4) and major spine surgery involving > 3 levels (p = 0.012; OR 3.0, CI 1.3-7.2) are associated with developing an ileus postoperatively. Conclusion: Surgeries of the lumbar spine as well as those involving > 3 levels are associated with developing a postoperative ileus. Further studies are needed to expand on possible risk factors and to better understand the mechanism underlying postoperative ileus in spine surgery patients.

show abstract

Usage of Chewing Gum in Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis

Abstract: 1.

Cited by 14 publications

References 28 publications

Value in Scoliosis Surgery

Value in Scoliosis Surgery

Incidence and Risk Factors for Postoperative Ileus after Posterior Surgery in Adolescent Idiopathic Scoliosis

What Are Risk Factors for an Ileus After Posterior Spine Surgery?—A Case Control Study

Contact Info

Product

Resources

About