Results and Complications After Spinal Fusion for Neuromuscular Scoliosis in Cerebral Palsy and Static Encephalopathy Using Luque Galveston Instrumentation

OBJECTIVESpinal fusion is used in the treatment of pediatric neuromuscular scoliosis (NMS) to improve spine alignment and delay disease progression. However, patients with NMS are often medically complex and require a higher level of care than those with other types of scoliosis, leading to higher treatment costs. The purpose of this study was to 1) characterize the cost of pediatric NMS fusion in the US and 2) determine hospital characteristics associated with changes in overall cost.METHODSPatients were identified from the National Inpatient Sample (2012 to the first 3 quarters of 2015). Inclusion criteria selected for patients with NMS, spinal fusion of at least 4 vertebral levels, and elective hospitalization. Patients with no cost information were excluded. Sociodemographics, treating hospital characteristics, disease etiology/severity, comorbidities, length of stay, and hospital costs were collected. Univariable analysis and multivariable gamma log-link regression were used to determine hospital characteristics associated with changes in cost.RESULTSA total of 1780 weighted patients met inclusion criteria. The median cost was $68,815. Following multivariable regression, both small (+$11,580, p < 0.001) and medium (+$6329, p < 0.001) hospitals had higher costs than large hospitals. Rural hospitals had higher costs than urban teaching hospitals (+$32,438, p < 0.001). Nonprofit hospitals were more expensive than both government (–$4518, p = 0.030) and investor-owned (–$10,240, p = 0.001) hospitals. There was significant variability by US census division; compared with the South Atlantic, all other divisions except for the Middle Atlantic had significantly higher costs, most notably the West North Central (+$15,203, p < 0.001) and the Pacific (+$22,235, p < 0.001). Hospital fusion volume was not associated with total cost.CONCLUSIONSA number of hospital factors were associated with changes in fusion cost. Larger hospitals may be able to achieve decreased costs due to economies of scale. Regional differences could reflect uncontrolled-for variability in underlying patient populations or systems-level and policy differences. Overall, this analysis identified multiple systemic patterns that could be targets of further cost-related interventions.

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Comparative cost–utility analysis of postoperative discharge pathways following posterior spinal fusion for scoliosis in non-ambulatory cerebral palsy patients

Spine Deformity ◽

10.1007/s43390-021-00362-y ◽

2021 ◽

Author(s):

K. Aaron Shaw ◽

Vahé Heboyan ◽

Nicholas D. Fletcher ◽

Joshua S. Murphy

Keyword(s):

Cerebral Palsy ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Comparative Cost

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Preoperative hematocrit and platelet count are associated with blood loss during spinal fusion for children with neuromuscular scoliosis

Journal of Perioperative Practice ◽

10.1177/1750458920962634 ◽

2021 ◽

pp. 175045892096263

Author(s):

Margaret O Lewen ◽

Jay Berry ◽

Connor Johnson ◽

Rachael Grace ◽

Laurie Glader ◽

...

Keyword(s):

Platelet Count ◽

Blood Loss ◽

Spinal Fusion ◽

Regression Trees ◽

Classification And Regression Trees ◽

Neuromuscular Scoliosis ◽

Independent Variables ◽

Estimated Blood Loss ◽

Laboratory Results ◽

Classification And Regression

Aim To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. Methods Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children’s hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Secondary outcomes were volumes of packed red blood cells, fresh frozen plasma, and platelets transfused intraoperatively. Independent variables were preoperative blood counts, coagulation studies, and demographic and surgical characteristics. Relationships between estimated blood loss, transfusion volumes, and independent variables were assessed using bivariable analyses. Classification and Regression Trees were used to identify variables most strongly correlated with outcomes. Results In bivariable analyses, increased estimated blood loss was significantly associated with higher preoperative hematocrit and lower preoperative platelet count but not with abnormal coagulation studies. Preoperative laboratory results were not associated with intraoperative transfusion volumes. In Classification and Regression Trees analysis, binary splits associated with the largest increase in estimated blood loss were hematocrit ≥44% vs. <44% and platelets ≥308 vs. <308 × 109/L. Conclusions Preoperative blood counts may identify patients at risk of increased bleeding, though do not predict intraoperative transfusion requirements. Abnormal coagulation studies often prompted preoperative intervention but were not associated with increased intraoperative bleeding or transfusion needs.

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Cerebral Palsy

Pediatrics in Review ◽

10.1542/pir.16.11.411 ◽

1995 ◽

Vol 16 (11) ◽

pp. 411-418

Author(s):

Lawrence T. Taft

Keyword(s):

Cerebral Palsy ◽

Prevalence Rate ◽

Brain Lesion ◽

Motor Deficit ◽

Motor Disorder ◽

Term Infants ◽

Live Births ◽

The Past ◽

Technological Advances ◽

Static Encephalopathy

To be classified as cerebral palsy (CP), there must be difficulty in neuromotor control, a nonprogressive brain lesion, and an injury to the brain that occurred before it was fully mature. The term "cerebral palsy" should be used only if a static encephalopathy exists. If there is any question that a progressive central nervous system disorder exists, the term "cerebral palsy" should not be used diagnostically until the status of the lesion is clarified. Although the primary abnormality must be a motor deficit, often there are many associated symptoms of cerebral dysfunction present. Incidence and Prevalence The prevalence of CP has changed very little over the past 40 years, in spite of many technological advances that have decreased mortality in compromised preterm and full-term infants. The prevalence rate has been estimated to be between 2 and 5 per 1000 live births. At 12 months of age, the prevalence rate was estimated to be 5.2 per 1000, but at 7 years of age, the rate was estimated to be 2 per 1000 live births. This indicates that many children who showed signs or experienced symptoms suggesting a motor disorder did not have CP on follow-up. The past 3 decades have seen an increased survival rate of very small preterm infants, resulting in a change in the percentage rates of the different clinical types of motor disabilities among patients classified as having CP.

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