Unplanned return to operation room (OR) following growing spinal constructs (GSCs) in early onset scoliosis (EOS)-a multi-centric study

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To evaluate the incidence and risk factors associated with the unplanned return to OR in EOS. Medical records of 51 patients of EOS operated at three different centres using various types of GSCs were evaluated for complications requiring unplanned surgeries. Data were analysed to find out rate of unplanned surgeries in relation to the aetiology, age and Cobb angle at index surgery, type of implant, cause of unplanned surgery, and management required. Out of 51 patients, three did not meet inclusion criteria. Forty-eight patients of EOS operated by GSCs with a mean age of 6.7years (range 2-12years) with an average follow-up of 67.3months were studied. There were 30 congenital, 10 idiopathic, 4 syndromic, and 4 neuromuscular cases. Thirty-nine out of 48 patients had one or more unplanned surgeries on follow-up (81.25%). Out of total 248 surgeries following index procedure, 82 were unplanned surgeries (33.06%), including 53 implant revisions, 12 implant-removal, 14 debridement, and 2 flaps. The common complications were 24.14% rod/screw breakage, 42.53% anchor pull-out, 16.09% infections, 6.90% wound dehiscence, and 4.6% neuro deficits. Unplanned surgeries were significantly higher in syndromic (58.8%) and neuromuscular (52.9%) than congenital (27.2%) and idiopathic (37.8%) cases (p < 0.05). Age at index procedure < 5years had higher unplanned surgeries than age > 5years (2.5 and 1.23 per patient, respectively, p< 0.05). Type of implant and initial Cobb angle did not significantly affect the rate of unplanned surgeries (p > 0.05) CONCLUSION: GSCs in EOS require a frequent revisit to operation room which should be well understood by the surgeon and parents.