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Evaluation of High-risk Patients Undergoing Spinal Surgery: A Matched Case Series

Miller, Nancy Hadley MD* †; Benefield, Elise RN*; Hasting, Laurel BA*; Carry, Patrick BA*; Pan, Zhoaxing PhD; Erickson, Mark A. MD* †

Journal of Pediatric Orthopaedics:
doi: 10.1097/BPO.0b013e3181df16ac
Cerebral Palsy

Background: Neuromuscular (NM) spinal deformities necessitating surgical intervention present a difficult challenge to the medical community. Underlying comorbidities lead to extended hospital stays, significant complications, and social challenges in the extensive perioperative period. In response to this problem, a therapeutic algorithm, the Care Pathway for Spinal Surgery (CAPSS) has been developed at our institution to address this complex medical issue.

Methods: In 1999, a multidisciplinary team developed a treatment protocol, CAPSS, that emphasized perioperative work up and operative scheduling under the direction of a dedicated care coordinator. A case series analysis was conducted to compare the surgical outcomes from before and after CAPSS implementation. Statistical analyses were performed on a carefully paired subset of NM patients (N=9). Outcome measures were hospital length of stay (LOS), pediatric intensive care unit LOS, number of days intubated, surgical estimated blood loss, postoperative curve magnitude, percent curve correction, and perioperative complications.

Results: Statistical analyses indicated that the use of CAPSS provided significant reduction in overall LOS, pediatric intensive care unit LOS, and perioperative complication rate within this patient group.

Conclusions: CAPSS is an effective method to improve perisurgical care within the NM patients with spinal deformity necessitating operative stabilization.

Level of Evidence: III—Retrospective comparative study.

Author Information

*Department of Orthopaedic Surgery, The Musculoskeletal Research Center

Pediatric Research Institute, The Children's Hospital, Aurora

Department of Orthopaedic Surgery, University of Colorado, Denver, CO

None of the authors received any financial support for this study.

Reprints: Nancy Hadley Miller, MD, The Children's Hospital Aurora, CO, 13123 East 16th Avenue, B060 Aurora, CO, 80045. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.