Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose of this investigation was to examine the impact of body mass index (BMI) on 30-day outcomes after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).METHODSThe American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2013 and 2014) was reviewed. Patients 10–18 years of age who had undergone fusion of 7 or more spinal levels for AIS were included. Thirty-day outcomes (complications, readmissions, and reoperations) were compared based on patient BMI per age- and sex-adjusted growth charts as follows: normal weight (NW; BMI < 85th percentile), overweight (OW; BMI 85th–95th percentile), and obese (OB; BMI > 95th percentile).RESULTSPatients eligible for study numbered 2712 (80.1% female and 19.9% male) and had a mean age of 14.4 ± 1.8 years. Average BMI for the entire cohort was 21.9 ± 5.0 kg/m2; 2010 patients (74.1%) were classified as NW, 345 (12.7%) as OW, and 357 (13.2%) as OB. The overall complication rate was 1.3% (36/2712). For NW and OW patients, the complication rate was 0.9% in each group; for OB patients, the rate was 4.2% (p < 0.001). The 30-day readmission rate was 2.0% (55/2712) for all patients, 1.6% for NW patients, 1.2% for OW patients, and 5.0% for OB patients (p < 0.001). The 30-day reoperation rate was 1.4% (39/2712). Based on BMI, this reoperation rate corresponded to 0.9%, 1.2%, and 4.8% for NW, OW, and OB patients, respectively (p < 0.001). After controlling for patient age, number of spinal levels fused, and operative/anesthesia time on multiple logistic regression analysis, obesity remained a significant risk factor for complications (OR 4.61), readmissions (OR 3.16), and reoperations (OR 5.33; all p < 0.001).CONCLUSIONSBody mass index may be significantly associated with short-term outcomes after long-segment fusion procedures for AIS. Although NW and OW patients may have similar 30-day outcomes, OB patients had significantly higher wound complication, readmission, and reoperation rates and longer hospital stays than the NW patients. The findings of this study may help spine surgeons and patients in terms of preoperative risk stratification and perioperative expectations.

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P80. The impact of body mass index (BMI) on postoperative outcomes following posterior spinal fusion in neuromuscular scoliosis

The Spine Journal ◽

10.1016/j.spinee.2019.05.505 ◽

2019 ◽

Vol 19 (9) ◽

pp. S195-S196

Author(s):

Azeem T. Malik ◽

Robert Tamer ◽

Elizabeth Yu ◽

Jeffery Kim ◽

Safdar N. Khan

Keyword(s):

Body Mass Index ◽

Spinal Fusion ◽

Body Mass ◽

Posterior Spinal Fusion ◽

Neuromuscular Scoliosis ◽

Postoperative Outcomes ◽

The Impact

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The Impact of Body Mass Index (BMI) on 30-day Outcomes Following Posterior Spinal Fusion in Neuromuscular Scoliosis

Spine ◽

10.1097/brs.0000000000003084 ◽

2019 ◽

Vol 44 (19) ◽

pp. 1348-1355

Author(s):

Azeem Tariq Malik ◽

Robert Tamer ◽

Elizabeth Yu ◽

Jeffery Kim ◽

Safdar N. Khan

Keyword(s):

Body Mass Index ◽

Spinal Fusion ◽

Body Mass ◽

Posterior Spinal Fusion ◽

Neuromuscular Scoliosis ◽

The Impact

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Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Global Spine Journal ◽

10.1177/2192568220935107 ◽

2020 ◽

pp. 219256822093510

Author(s):

Yoji Ogura ◽

Steven D. Glassman ◽

Daniel Sucato ◽

M. Timothy Hresko ◽

Leah Y. Carreon

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Pedicle Screw ◽

Standard Procedure ◽

Pedicle Screws ◽

Posterior Spinal Fusion ◽

Proximal Junctional Kyphosis ◽

The Impact ◽

Junctional Kyphosis

Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

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The Impact of Posterior Spinal Fusion (PSF) on Coronal Balance in Adolescent Idiopathic Scoliosis (AIS): A New Classification and Trends in the Postoperative Period

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001622 ◽

2020 ◽

Vol 40 (9) ◽

pp. e788-e793 ◽

Cited By ~ 1

Author(s):

Jason B. Anari ◽

Aaron Tatad ◽

Patrick J. Cahill ◽

John M. Flynn

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Postoperative Period ◽

Posterior Spinal Fusion ◽

New Classification ◽

Coronal Balance ◽

The Impact

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Accelerated Discharge Protocol for Posterior Spinal Fusion (PSF) in Adolescent Idiopathic Scoliosis (AIS) Decreased Hospital Charges 21% without Increasing Post-Operative Complications

10.1542/peds.140.1_meetingabstract.104 ◽

2017 ◽

Author(s):

Austin E. Sanders ◽

Lindsay Andras ◽

Ted Sousa ◽

David L. Skaggs

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Hospital Charges ◽

Operative Complications ◽

Discharge Protocol ◽

Post Operative Complications

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Emergency Department Visits After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001444 ◽

2019 ◽

Vol 40 (7) ◽

pp. e629-e633

Author(s):

Andrew B. Harris ◽

Majd Marrache ◽

Varun Puvanesarajah ◽

Micheal Raad ◽

Richard L. Skolasky ◽

...

Keyword(s):

Emergency Department ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Emergency Department Visits

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Incidence of Pleural Fluid and Its Associated Risk Factors After Posterior Spinal Fusion in Patients With Adolescent Idiopathic Scoliosis

Spine ◽

10.1097/brs.0000000000001861 ◽

2017 ◽

Vol 42 (8) ◽

pp. 603-609 ◽

Cited By ~ 2

Author(s):

Kazunori Hayashi ◽

Hidetomi Terai ◽

Hiromitsu Toyoda ◽

Akinobu Suzuki ◽

Masatoshi Hoshino ◽

...

Keyword(s):

Risk Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Pleural Fluid ◽

Posterior Spinal Fusion ◽

Associated Risk Factors

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Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04104-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Chris Yuk Kwan Tang ◽

Vijay H. D. Kamath ◽

Prudence Wing Hang Cheung ◽

Jason Pui Yin Cheung

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Predictive Factors ◽

Posterior Spinal Fusion ◽

Male Gender ◽

Intraoperative Blood Loss ◽

Operative Blood Loss ◽

Operation Duration

Abstract Background Adolescent idiopathic scoliosis (AIS) is a common spinal deformity. Posterior spinal fusion remains an important surgical treatment for AIS. This study aims to determine the predictive factors for intraoperative blood loss in AIS surgery. Methods Patients who had undergone posterior spinal fusion for adolescent idiopathic scoliosis in a single university hospital were reviewed over a 7-year period. Predictive factors for intra-operative blood loss were studied by multivariate analysis to derive a regression model. Receiver operating characteristic analysis was performed to determine the cut-off values of factors contributing to significant intraoperative blood loss (≥500 ml). Results Two hundred and twelve patients were included. Intraoperative blood loss was found to be correlated with gender (rs = 0.30 (0.17–0.43)), preoperative hemoglobin level (rs = 0.20 (0.04–0.31)), preoperative Cobb angle (rs = 0.20 (0.02–0.29)), number of fused levels (rs = 0.46 (0.34–0.58)), operation duration (rs = 0.65 (0.54–0.75)), number of anchors (rs = 0.47 (0.35–0.59)), and p-value ranged from < 0.001 to < 0.05. Significant intraoperative blood loss was influenced by the male gender, operation duration greater than 257.5 min and more than 10 anchors used. Conclusions Male gender, increased operation duration and higher number of anchors predicted higher intra-operative blood loss.

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