Quantifying Anesthesia Exposure in Growing Rod Treatment for Early Onset Scoliosis. Issue 8 (December 2017)

• Record Type: Journal Article
• Authors: Goldstein, Matthew J.; Kabirian, Nima; Pawelek, Jeff B.; Arandi, Navid R.; Mundis, Gregory M.; Yaszay, Burt; Newton, Peter O.; Akbarnia, Behrooz A.
• Is Part Of: Journal of pediatric orthopaedics. Volume 37:Issue 8(2017)
• Publication Date: 2017-12
• Subjects: growing rods -- early-onset scoliosis -- anesthesia exposure; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000000740
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: Growing rod (GR) treatment for early-onset scoliosis requires repeated anesthesia exposure (AE). At a minimum, GR treatment requires AE for diagnostic imaging, index GR surgery, periodic lengthenings, and final fusion. Adjunct procedures and complication-related procedures also increase AE. To our knowledge, this is the first study to quantify AE in GR treatment and to establish preoperative expectations. Methods: A single-center retrospective review of 16 patients who completed GR treatment and underwent final fusion. Duration of all AE related to GR treatment for "standard" care procedures (ie, advanced imaging, index surgery, lengthenings, final fusion) and "associated" care procedures (ie, revisions, adjunctive surgical procedures, wound-related complications) were reviewed. Etiologies were classified per the classification of early-onset scoliosis. Mean total anesthesia time (TAT) was tallied and analyzed for standard care and associated care procedures. Results: There were 5 syndromic, 8 neuromuscular, and 3 idiopathic patients. The mean age at the first AE event related to GR treatment was 7.4 years (range, 3.8 to 11 y). Mean age at the index GR surgery and final fusion was 8.1 years (range, 3.9 to 14.4 y) and 12.8 years (range, 9.7 to 19 y), respectively. The percentage of TAT for each procedural category was 7% for advanced imaging, 14% for index GR, 14% for lengthenings, 21% for final fusion, 27% for revisions, 9% for adjunct surgery, and 9% for wound complications. Standard care procedures accounted for 55% of TAT, whereas associated care procedures accounted for 45%. Conclusions: This study quantified expected duration of AE in GR treatment. Revisions and final fusion contributed most to TAT. Given the recent controversy of repeated AE in young children, efficiency measures should be implemented to reduce AE and avoid duplication without compromising the goals of surgical treatment. Associated care procedures accounted for 45% of the total AE. Level of Evidence: Level IV.