Unplanned Return to the Operating Room in Patients With Adolescent Idiopathic Scoliosis

Are We Doing Better With Pedicle Screws?

Amer F. Samdani, MD; Eric J. Belin, MD; James T. Bennett, MD; Joshua M. Pahys, MD; Michelle C. Marks, PT, MA; Firoz Miyanji, MD; Harry L. Shuffl ebarger, MD; Baron S. Lonner, MD; Peter O. Newton, MD; Randal R. Betz, MD; Patrick J. Cahill, MD

Disclosures

Spine. 2013;38(21):1842-1847. 

In This Article

Abstract and Introduction

Abstract

Study Design. Prospective, longitudinal cohort.

Objective. To evaluate the incidence, timing, and risk factors for reoperation in patients with adolescent idiopathic scoliosis (AIS) treated with pedicle screws (PSs) compared with hybrid (Hb) constructs.

Summary of Background Data. Rates of return to the operating room (OR) after definitive fusion for AIS vary, with a paucity of data on PS constructs.

Methods. A prospective multicenter database was retrospectively queried to identify consecutive patients with AIS who underwent posterior spinal fusion with either PS or Hb constructs with a minimum 2-year follow-up. All reoperations were stratified into an early group (<60 d) or a late group (>60 d). Univariate and multivariate logistical analyses were performed to identify potential risk factors related to reoperation.

Results. A total of 627 patients met the inclusion criteria (PS = 540, Hb = 87). There was a statistically significant difference in the rate of reoperations between the PS (3.5%) and Hb groups (12.6%), P < 0.001. Early return to the OR occurred in 2.0% of the patients with PS compared with 3.4% in the Hb group, P = 0.43. Late returns to the OR occurred in 1.5% of PS group versus 9.2% of the Hb group, P < 0.001. Multivariate analysis revealed longer operating time as an independent risk factor for an unplanned return to the OR in patients treated with PSs (P < 0.05).

Conclusion. Our results suggest that patients with AIS treated with PS have decreased rates of unplanned return to the OR when compared with patients with Hb constructs. The majority of returns to the OR were early (<60 d) for the PS group compared with late (>60 d) for the Hb group. Longer operative times increased the risk of unplanned reoperation for the PS group.

Level of Evidence: 3

Introduction

There is wide variability of data reported for complications (rates ranging from 0% to 89%) associated with the operative treatment of adolescent idiopathic scoliosis (AIS).[1–6] Several studies have reported on unplanned returns to the operating room (OR) after AIS surgery;[7–11] however, only a small subset of the patients in these series were treated with pedicle screw (PS) constructs.

In 2008, Lehman et al[12] reported a 4.4% reoperation rate (3 with late infections and 2 for adding on) in 114 patients with AIS who underwent PS fixation with a 3-year minimum follow-up. Suk et al[13] reported a reoperation rate of 1.5% for early infections in 203 patients with AIS who underwent segmental PS fixation and had a 5-year minimum follow-up. To date, Kuklo et al[14] have published the only study with a substantial number of patients with PS constructs and a comparison group with hybrid (Hb) constructs; however, this was a retrospective study, and potential risk factors for unplanned return to the OR were not reported.

The purpose of this study is to define the incidence and timing of reoperation in patients with AIS treated with either PS or Hb constructs. In addition, this study seeks to identify potential risk factors that are associated with an unplanned return to the OR for patients with AIS treated with PSs.

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