Concomitant procedures with early-onset scoliosis rib-based surgeries

Abstract

Study design: Retrospective cohort study.

Objective: To determine if additional procedures can be safely performed under the same anesthesia as early-onset scoliosis (EOS) rib-based surgeries. EOS patients with rib-based implants often require repeated invasive surgery to treat their spinal deformity, with associated risks of cognitive development impairment from multiple anesthetic exposures. Many of these patients have comorbidities that require additional procedures, possibly increasing the risk of adverse outcomes.

Methods: We performed a retrospective review of EOS patients treated with rib-based implants with at least 2 year follow up at a single institution. Patients were divided into two cohorts: Group A included patients who never had another procedure in conjunction with a rib-based implant insertion, expansion, and/or revision surgery throughout their treatment and Group B included patients who had at least one other procedure operate in conjunction with rib-based implant surgery. Univariate analysis was performed to compare demographics, surgical parameters, and incidence of complication between the two groups. A subanalysis of patients who experienced an infection requiring surgery in Group A and Group B was also performed to further analyze the impact of concomitant procedures.

Results: 147 EOS patients underwent rib-based growing instrumentation at our institution. 98 patients (Group A) did not have another procedure occur under the same anesthetic as a rib-based implant surgery and 49 patients (Group B) had another procedure performed in conjunction with a rib-based implant surgery. Gender, etiology, BMI, length of follow up and number of rib-based implant procedures were similar between both cohorts (p = 0.91, 0.24, 0.28, 0.91, 0.77, respectively). The total surgical and anesthesia time was significantly longer in the patients undergoing concomitant procedures (Group B) (p < 0.0001, p < 0.0001, respectively). Among the patients in Group B, Otolaryngology was the most common department adding surgical care, followed by non-spine orthopaedics and general surgery. Mircrolaryngoscopy and bronchoscopy were performed most often (24 procedures), followed by cerumen removal under anesthesia (22 procedures), ear tube insertion (19 procedures) and bronchoscopy (19 procedures). Infection requiring irrigation and debridement was the most common complication found in both cohorts. Although Group B had a significantly lower number of patients who experienced complications (p = 0.002), the complication rate per procedure was 14% in Group A and 16% in Group B. When performing a subanalysis on patients who experienced an infection requiring irrigation and debridement surgery among Group A (47 patients) and Group B (8 patients), gender, etiology, BMI, length of follow up, and number of rib-based implant procedures were similar (p = 0.71, 0.26, 0.06, 0.69, 0.84 and, respectively). The total surgical and anesthesia time were similar (p = 0.11 and 0.13, respectively). In addition, the number of irrigation and debridement surgeries needed to treat each infection even was similar between the two groups (p = 0.59).

Conclusion: There was no difference in complication rate per procedure when other services operate in conjunction with rib-based implant surgery.

Level of evidence: III.

Keywords: Anesthesia; Early onset scoliosis; Infection; Rib-based implant; Rib-based surgeries.