Abstract
Background: Scoliosis is among interventions with high postoperative complication rates due to the characteristics of the surgery, where blood loss, transfusion and fluid requirements can be increased. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and presented here. Objective: To describe intraoperative and postoperative outcomes in patients under 18 years old in scoliosis surgery included in the initial study and to propose improvement and implementation measures. Methods: A secondary analysis of patients undergoing scoliosis surgery from 1 January 2014 to 17 May 2017 was undertaken in our institution—Necker Enfants Malades university hospital. The study was approved by the Ethics Committee. Results: There were 116 patients with a mean age of 147.5 ± 40.2 months. Twenty-eight patients (24.1%) presented intraoperative and/or postoperative complications. The most common intraoperative complication was hemorrhagic shock in 3 patients (2.6%). The most common postoperative organ failure was neurologic in seven patients (6%), respiratory in 3 patients (2.6%), cardio-circulatory in 2 patients (1.7%) and renal failure in 1 patient (0.9%). The most common postoperative infection was surgical wound sepsis in 8 patients (6.9%), urinary sepsis in 3 patients (2.6%), and abdominal sepsis and septicemia in 2 patients (1.7%). 12 patients (10.3%) had reoperations. Fifty-six patients (48.3%) had intraoperative transfusion. There was no in-hospital mortality. Conclusion: The portion of patients with intraoperative and or postoperative complications was 24.1%, integrating goal-directed therapies in this surgical setting could improve postoperative outcomes.
Highlights
IntroductionScoliosis surgery is one of the most commonly performed major elective surgeries in our hospital.This disorder of the vertebral column is classified as idiopathic or juvenile and non-idiopathic scoliosis (see Figure 1 and Figure 2 illustrating spine radiography in a 13-year-old child with neuromuscular scoliosis before and after a mini-invasive surgical technique).The etiopathology of juvenile scoliosis is unknown, whereas non-idiopathic scoliosis is associated with neuromuscular diseases, bone diseases or other syndromes
Scoliosis surgery is one of the most commonly performed major elective surgeries in our hospital.This disorder of the vertebral column is classified as idiopathic or juvenile and non-idiopathic scoliosis.The etiopathology of juvenile scoliosis is unknown, whereas non-idiopathic scoliosis is associated with neuromuscular diseases, bone diseases or other syndromes
Enhanced Recovery after Surgery (ERAS) protocols integrate different patient management aspects that have the objectives to enhance recovery after surgery [3]. These include among other aspects, intraoperative transfusion protocols guided with the point of care viscoelastic methods in hemorrhagic settings, optimal intraoperative fluid therapy management using validated tools in children, intraoperative protective mechanical ventilation methods, minimally invasive surgical techniques and optimal intraoperative and postoperative pain management [3]-[9]
Summary
Scoliosis surgery is one of the most commonly performed major elective surgeries in our hospital.This disorder of the vertebral column is classified as idiopathic or juvenile and non-idiopathic scoliosis (see Figure 1 and Figure 2 illustrating spine radiography in a 13-year-old child with neuromuscular scoliosis before and after a mini-invasive surgical technique).The etiopathology of juvenile scoliosis is unknown, whereas non-idiopathic scoliosis is associated with neuromuscular diseases, bone diseases or other syndromes. We conducted a monocentric observational study in neurosurgical, abdominal surgical and orthopedic patients to determine predictors of intraoperative and postoperative outcomes [2]. In this cohort of 594 patients, some patients underwent scoliosis surgery. A monocentric retrospective observational study was undertaken earlier to determine predictors of intraoperative and postoperative outcomes in surgical patients. In this initial cohort, there were patients who underwent scoliosis surgery, and a secondary analysis to describe outcomes in these patients was realized and presented here.
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