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Larger Curve Magnitude is Associated with Increased Perioperative Healthcare Resource Utilization: A Multi‐Center Analysis of 422 Adolescent Idiopathic Scoliosis Curves: Paper #5

Miyanji, Firoz MD, FRCSC; Slobogean, Gerard P. MD, MPH; Samdani, Amer F. MD; Betz, Randal R. MD; Reilly, Christopher W. MD, FRCSC; Slobogean, Bronwyn PA‐C; Newton, Peter O. MD

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Canada

Summary: Lengthy surgical waitlists for patients with Adolescent Idiopathic Scoliosis (AIS) often result in significant increases in curve magnitude. Curve progression has been suggested to increase the predicted complexity of surgery with implications on healthcare resource utilization. We found that larger curves lead to increased surgical time, number of levels instrumented, and the need for blood transfusion confirming that prolonged waitlists for scoliosis result in greater utilization of perioperative healthcare resources.

Introduction: Lengthy waitlists for surgery are common in publicly funded healthcare systems. Prolonged delays in scoliosis surgery can however lead to increasing deformity which can have significant implications on the surgical and peri‐operative care required, subsequently impacting healthcare resources with greater costs to the healthcare system. We aimed to determine whether surgical correction of larger AIS curves increased the use of health care resources, and to identify potential predictors associated with increased peri‐operative healthcare resource utilization in the surgical care of AIS patients.

Methods: A prospective longitudinal multi‐center study evaluating operative outcomes of AIS yielded patients with Lenke 1A and 1B curves. Surgical time, number of levels instrumented, length of hospitalization, lowest instrumented vertebrae (LIV) and allogenic blood transfusion were the primary outcomes studied. Multivariable regression was used to identify potential predictors influencing these healthcare resources.

Results: 422 subjects with a mean age of 15±2 years were included. The mean thoracic curve was 51.6° ±9.5°. Larger curves lead to increase in surgical time (p<0.0001), number of levels instrumented (p<0.0001), and the need for blood transfusion with every 10 degree increase associated with a 1.5 times greater odds for receiving blood transfusion. Surgeon, bone graft method, and LIV were strong predictors of surgical time (R2 =0.73). Length of hospital stay was influenced by surgeon and intra‐operative blood loss (R2=0.59), while percentage curve correction, upper instrumented vertebrae, and surgeon were predictive of the number of levels instrumented (R2=0.66).

Conclusion: Correction of larger curves is associated with increased utilization of perioperative healthcare resources, specifically surgical time, number of levels instrumented, and the need for blood transfusion.

Significance: Policies affecting prolonged waitlists for scoliosis surgery must consider the added costs to the healthcare system when treating larger curves and should focus on reducing the wait times.

© 2010 Lippincott Williams & Wilkins, Inc.

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