Unplanned Return to OR (UPROR) for Children With Early-Onset Scoliosis (EOS): A Comprehensive Evaluation of All Diagnoses and Instrumentation Strategies

Study Design: Retrospective analysis of a prospectively collected multi-center database. Objectives: Our goal was to study unplanned return to the OR (UPROR, a postoperative complication that could not be treated without an additional anesthetic) as a function of C-EOS diagnosis and implant type. Summary of Background Data: Growing concerns over the impact of multiple anesthetic events on the young brain have focused attention on limiting UPROR in early-onset scoliosis (EOS). Methods: We studied all patients with a diagnosis of EOS who had surgical implantation of growing instrumentation from October 4, 2010, to September 27, 2015, with a minimum two-year follow-up. Among the complications requiring surgical treatment (revision for implant or anchor failure, infection, or implant removal), we analyzed all UPROR events—those that required a separate anesthetic (could not be treated as part of a planned surgical lengthening) within the first two years after initial implantation. UPROR was analyzed by diagnosis, deformity type, and implant strategy using the C-EOS classification. Results: A total of 369 patients met inclusion criteria. Eighty-five of the 369 (23%) required unplanned trips to the operating room for various reasons. The C-EOS group at highest risk of an unplanned trip to the operating room is the hyperkyphotic neuromuscular (M3+, 14/85) cohort, followed closely by the congenital (C3N, 9/85) and neuromuscular (M3N, 8/85) groups with normal sagittal profiles and Cobb angles between 50° and 90°. Implant strategy was significantly related to risk of UPROR (p = .009), with traditional implants (VEPTR/TGR) being less likely to have an UPROR event. Conclusions: Growing instrumentation to treat EOS, when considered comprehensively, results in a true unplanned reoperation rate within two years of implantation of 23% (85/369). UPROR events are more common with certain C-EOS groups (hyperkyphotic neuromuscular deformities) and implant strategies. Families should be counseled that unplanned anesthetics are common with any implant strategy available today. Level of Evidence: Level III, therapeutic.