Do Overweight Adolescent Idiopathic Scoliosis (AIS) Patients Have an Increased Perioperative Risk for Posterior Spinal Fusion (PSF) Surgery?: A Propensity Score Matching Analysis of 374 AIS Patients.

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to compare the perioperative outcome of posterior spinal fusion (PSF) between overweight (OW) adolescent idiopathic scoliosis (AIS) patients and the healthy-weight (HW) patients using propensity score matching analysis. SUMMARY OF BACKGROUND DATA: Obesity was found to increase postoperative surgical complications compared with the nonobese group. In scoliosis correction surgery, association of OW and perioperative risks had been explored, but most studies were retrospective in nature. METHODS: From 374 patients, two comparable groups were matched using propensity score matching analysis with one-to-one nearest neighbor matching and a caliper of 0.2. There were 46 HW and OW patients in each group. The main outcome measures were intraoperative blood loss, use of allogeneic blood transfusion, operative time, duration of hospital stay post-surgery, total patient-controlled analgesia (PCA) morphine usage, perioperative complications, side bending flexibility (SBF), and correction rate (%). RESULTS: The mean age was 13.3 ±â€Š1.7 and 13.2 ±â€Š1.7 years for HW and OW groups, respectively. The majority of the patients were Lenke 1 curves; 32.6% (HW) and 26.1% (OW) with an average Cobb angle of 69.0 ±â€Š19.1° and 68.8 ±â€Š18.4° for each group, respectively. The two groups were comparable. The operation time was 145.2 ±â€Š42.2 and 154.4 ±â€Š48.3 minutes for HW and OW groups, respectively (P > 0.05). The intraoperative blood loss was almost similar in both groups; 955.1 ±â€Š497.7 mL (HW group) and 1011.8 ±â€Š552.7 mL (OW group) (P > 0.05). Total PCA morphine used was higher in OW group (30.4 ±â€Š22.7 mg) than in the HW group (16.2 ±â€Š11.3 mg). No complication was observed in HW group, while in OW group, one patient (2.2%) developed intraoperative seizure. CONCLUSION: OW AIS patients (≥85th percentile) had similar mean operative time, intraoperative blood loss, allogeneic transfusion rate, length of stay, and perioperative complications compared with HW AIS patients. LEVEL OF EVIDENCE: 3.

Perioperative Outcome of Single Stage Posterior Spinal Fusion for Severe Adolescent Idiopathic Scoliosis (AIS) (Cobb Angle ≥90°): The Role of a Dual Attending Surgeon Strategy.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the perioperative outcome of dual attending surgeon strategy for severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle more than or equal to 90°. SUMMARY OF BACKGROUND DATA: The overall complication rate for AIS remains significant and is higher in severe scoliosis. Various operative strategies had been reported for severe scoliosis. However the role of dual attending surgeon strategy in improving the perioperative outcome in severe scoliosis has not been investigated. METHODS: The patients were stratified into two groups, Cobb angles 90° to 100° (Group 1) and more than 100° (Group 2). Demographic, intraoperative, preoperative, and postoperative day 2 data were collected. The main outcome measures were intraoperative blood loss, use of allogeneic blood transfusion, operative time, duration of hospital stay postsurgery, and documentation of any perioperative complications. RESULTS: Eighty-five patients were recruited. The mean age for the whole cohort was 16.2 ±â€Š5.2 years old. The mean age of Group 1 was 16.7 ±â€Š5.7 and Group 2 was 15.6 ±â€Š4.8 years old. The majority of the patients in both groups were Lenke 2 curves with the average Cobb angle of 93.9 ±â€Š3.0° in Group 1 and 114.2 ±â€Š10.2° in Group 2. The average operative time was 198.5 ±â€Š47.5 minutes with an average blood loss of 1699.5 ±â€Š939.3 mL. The allogeneic blood transfusion rate was 17.6%. The average length of stay postoperation was 71.6 ±â€Š22.5 hours. When comparing the patients between Group 1 and Group 2, the operating time, total blood loss, allogeneic transfusion rate showed significant intergroup differences. Five complications were documented (one intraoperative seizure, one massive blood loss, one intraoperative loss of somatosensory evoked potential (SSEP) signal, and two superficial wound breakdown). CONCLUSION: Dual attending surgeon strategy in severe AIS more than or equal to 90° demonstrated an average operative time of 199 minutes, intraoperative blood loss of 1.7 L, postoperative hospital stay of 71.6 hours, and a complication rate of 5.9% (5/85 patients). Curves with Cobb angle more than 100° lead to longer operating time, greater blood loss, and allogeneic transfusion rate. LEVEL OF EVIDENCE: 4.