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

Children's Spine Study Group

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Scoliosis
Anesthetics
Operating Rooms
Reoperation
Retrospective Studies
Databases
Brain
Therapeutics
Infection

Keywords

  • C-EOS classification
  • Early-onset scoliosis
  • Growing instrumentation
  • Unplanned return to OR

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{dd488d7011e545a2ab624bbbc6f62ced,
title = "Unplanned Return to OR (UPROR) for Children With Early-Onset Scoliosis (EOS): A Comprehensive Evaluation of All Diagnoses and Instrumentation Strategies",
abstract = "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.",
keywords = "C-EOS classification, Early-onset scoliosis, Growing instrumentation, Unplanned return to OR",
author = "{Children's Spine Study Group} and Anari, {Jason B.} and Flynn, {John M.} and Cahill, {Patrick J.} and Vitale, {Michael G.} and Smith, {John T.} and Gomez, {Jaime A.} and Sumeet Garg and Baldwin, {Keith D.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2019.08.001",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Unplanned Return to OR (UPROR) for Children With Early-Onset Scoliosis (EOS)

T2 - A Comprehensive Evaluation of All Diagnoses and Instrumentation Strategies

AU - Children's Spine Study Group

AU - Anari, Jason B.

AU - Flynn, John M.

AU - Cahill, Patrick J.

AU - Vitale, Michael G.

AU - Smith, John T.

AU - Gomez, Jaime A.

AU - Garg, Sumeet

AU - Baldwin, Keith D.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - C-EOS classification

KW - Early-onset scoliosis

KW - Growing instrumentation

KW - Unplanned return to OR

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DO - 10.1016/j.jspd.2019.08.001

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JO - Spine Deformity

JF - Spine Deformity

SN - 2212-134X

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