Older fusion-surgery age in congenital scoliosis patients is a risk factor for extended length of stay, more estimated blood loss, longer fused segments and higher medical costs: a retrospective study

Background Contradictory opinions about whether early correction and fusion surgeries should be performed for congenital scoliosis (CS) patients at a young age exist. The objectives of this study were to analyze the association between patient characteristics and fusion-surgery outcomes in CS patients treated with spinal correction and fusion surgeries and to report risk factors for extended length of stay (LOS), more estimated blood loss (EBL), longer fused segments and higher medical costs. Methods We analyzed data of 1,207 CS inpatients treated with fusion surgeries in our institute from January 2010 - December 2019. All patients underwent spinal X-ray, CT, MRI, echocardiogram and urogenital ultrasound. We analyzed demographic and clinical information and outcome measures, including LOS, EBL, fused segments and medical costs. Results Age at fusion (OR = 1.053; p < 0.001), musculoskeletal defects (OR = 1.670; p = 0.004) and thoracic deformity (OR = 1.519; p = 0.03) were risk factors for extended LOS. Age at fusion (OR = 1.117; p < 0.001), male sex (OR = 1.813; p < 0.001), mixed defects (OR = 1.662; p = 0.027) and failure of formation (OR = 1.718; p = 0.021) were risk factors for more EBL. Age at fusion (OR = 1.213; p < 0.001) was a risk factor for longer fused segments. Age at fusion (OR = 1.091; p < 0.001) and thoracic deformity (OR = 1.853; p = 0.004) were risk factors for higher medical costs. Conclusions We found that older age at fusion in CS patients is a risk factor for extended LOS, more EBL, longer fused segments and higher medical costs with the risk increasing by 5–21 % for each year of age. Other identified risk factors include thoracic deformity for extended LOS; longer fused segments, higher medical costs, and musculoskeletal defects for extended LOS; and CS type (FF and MD) and sex (male) for more EBL.

Functional Respiratory Changes in Patients with Chest Wall Deformities Secondary to Autologous Costal Cartilage Harvest for Auricle Reconstruction

Background: The gold standard for auricle reconstruction is currently performed with autologous costal cartilage. This process is done at about nine years of age, but it leads to thoracic deformity, reported in up to 70% of the patients using aComputed Tomography (CT) scanner. Objective: The present study aims to determine if this deformity has functional implications for the patients. Methods: 54 patients were clinically evaluated and subjected to spirometry at least one year after the surgery. Results: Four cases had moderate pulmonary restriction, while seven had mild lung restriction. A total of 20.3% of the patients showed pulmonary restriction. The new results are particularly crucial for patients with preoperative (pre-op) ventilatory disease. Conclusion: In patients with thoracic deformity diagnosed by clinic exploration, spirometric abnormalities occur in up to 20.3%; when stratifying the risk by gender, the risk is only significant for women older than 15 years old.

Pain Managment of Multiple Rib Fractures on the Basis of Early Reduction and Fixation in Patients without Intensive Care Unit.

Objective: Blunt thoracic traumas are often complicated with rib fractures. The decision-making process of the treatment approaches not clear for clinicians. So, we aim to investigate the effect of surgical intervention on pain managment of patients as treatment indication. Methods: Cases with 3 or more rib fractures were evaluated in our study. 84 patients underwent open reduction from 2014 to 2018 and 127 patients were treated conservatively from 2014 to 2018 included in the study. Surgery was performed for all cases in first 24-36 hours and no patient needed intensive care. The results of hospitalization time, pneumonia, rates, thoracic deformity rates on 6.month thorax computerized tomography, intercostal blockage requirement, postoperative 6.month quality of life questionnaire for pain and clinical outputs of two groups were retrospectively analyzed. Results: The average hospitalization was found that it was significantly different in favor of the surgical group (z = 6.674; p <0.001). Thoracic deformity rates, intercostal blockage requirement was found to be different between the surgery and non-surgery groups (χ2=7.149;p<0.001), (χ2=22.462;p<0.001). Pain and quality of life scores had also significant difference in favor of the surgical group, respectively (z = 9.270; p <0.001) and (z = 8.796; p <0.001). Additionally there was statistical difference in pneumonia rates (p= 0.020). We did not reach a statistically significant result between the early and late groups in pain 1 and pain 2 results (p1: 0.727, p2: 0.069). Conclusions: There is no consensus on rib fractures. The results of our study suggest that open rib reduction and fixation can be better treatment option than conservative approach in terms of pneumonia rates, hospitalization time, thoracic deformity rates and pain management.