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Should We Worry About Waiting Times for Idiopathic Scoliosis Surgery?: Paper #6

Parent, Stefan MD, PhD; Roy‐Beaudry, Marjolaine MSc; Coindet, Emmanuelle; Joncas, Julie BSc; Mac‐Thiong, Jean‐Marc MD, PhD; Beauséjour, Marie; Labelle, Hubert MD

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Canada

Summary: Four years of consecutive AIS patients were analyzed to find if a long waiting time affects surgery and which characteristics can help to prioritize patients on a waiting list. Long waiting time implied considerable progression of curves, modification of surgical plan and increase of potential complications. Two variables were related to progression, age and curve type. Young patients and patients with double curves should be prioritized.

Introduction: Curve progression while on a waiting list is a significant concern in AIS, especially when waiting time exceeds 6 months. The goals of this study is to analyze if waiting time can affect surgical planning, to determine associated complications and to define criteria to prioritize patients on waiting lists.

Methods: 177 consecutive AIS patients who underwent scoliosis surgery between January 2006 and December 2009 were analyzed. Selected dependant variables: patient characteristics, waiting time, blood loss and surgical time. Patients with significant progression (>10°) while waiting for surgery were analyzed by three spine surgeons to determine if initial surgical planning needed to be changed. ANOVA tests were conducted on Cobb max differential (max Cobb angle when patient was enlisted compared to pre‐operative max Cobb angle).

Results: Mean waiting time was 225.7±127.3 days with a mean Cobb angle progression of 7.7°±8.6.47 patients had Cobb angle progression of more than 10° with a mean of 19.5°±8.1 and mean waiting time of 221.0+117.3 days. Surgical plan was modified for 28 patients between the time they were enlisted and the final surgery done; a combined anterior and posterior fusion was needed in 19 subjects, while longer posterior fusion was needed in 23 and pre‐operative halo traction in 2. These changes in surgical planning significantly increased blood loss to 1408ml compared to 1019ml (p=0.001) and surgery time increased from 323 to 418 min (p≤0.001) respectively for combined procedures versus single approaches. Analyses confirmed that young age (p≤0.001) and Lenke type (p=0.006) were related to progression, with Lenke types with 2 or more structural curves progressing more than single curve Lenke types.

Conclusion: Long waiting time is associated with significant curve progression, change in surgical planning and potential increase of complications. Young patients and patients with double curves should be prioritized.

Significance: This study demonstrates the importance of reducing waiting time for elective AIS surgery.

© 2010 Lippincott Williams & Wilkins, Inc.

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