The effect of surgical time on perioperative complications in adolescent idiopathic scoliosis cases. A propensity score analysis.
Document Type
Article
Publication Date
7-2024
Identifier
DOI: 10.1007/s43390-024-00839-6
Abstract
BACKGROUND: Posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS) can be lengthy and complication-ridden. The aim of this study was to evaluate the effect of surgical time on perioperative complications in this procedure when controlling for confounding variables with propensity score analysis.
METHODS: This was an IRB-approved review of electronic health records from 2010 to 2019 at a single tertiary care children's hospital. Patients undergoing PSIF were grouped into "short" (< 6 h) or "long" (≥ 6 h) surgical time groups. Outcome measures were estimated blood loss (EBL), cell saver transfusions, packed red blood cell (pRBC) transfusions, length of stay (LOS), intraoperative monitoring (IOM) alerts, hematocrit, ICU transfer, neurologic loss, surgical site infection, and 90-day readmissions. We controlled for age, sex, BMI, curve severity, number of segments fused, and surgeon factors.
RESULTS: After propensity score matching there were 113 patients in each group. The short surgical time group had lower EBL (median 715, IQR 550-900 vs median 875, IQR 650-1100 cc; p < 0.001), received less cell saver blood (median 120, IQR 60-168 vs median 160, IQR 97-225 cc; p = 0.001), received less intraoperative pRBCs (median 0, IQR 0-0 vs median 0, IQR 0-320, p = 0.002), had shorter average LOS (4.8 ± 1.7 vs 5.4 ± 2.5 days; p = 0.039), and fewer IOM alerts (4.3% vs 18%, p = 0.003).
CONCLUSIONS: Patients with shorter surgical times had less blood loss, received less transfused blood, had a shorter LOS, and fewer IOM alerts compared to patients with longer surgical times. Surgical times < 6 h may have safety and efficacy advantages over longer times.
LEVEL OF EVIDENCE: III.
Journal Title
Spine Deform
Volume
12
Issue
4
First Page
1053
Last Page
1060
MeSH Keywords
Humans; Scoliosis; Adolescent; Female; Propensity Score; Male; Spinal Fusion; Operative Time; Postoperative Complications; Length of Stay; Retrospective Studies; Child; Blood Loss, Surgical
Keywords
AIS; Blood loss; Perioperative complications; Scoliosis; Surgical time
Recommended Citation
Noe MC, Hagaman D, Sipp B, et al. The effect of surgical time on perioperative complications in adolescent idiopathic scoliosis cases. A propensity score analysis. Spine Deform. 2024;12(4):1053-1060. doi:10.1007/s43390-024-00839-6
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