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Perioperative Outcome of Single Stage Posterior Spinal Fusion for Severe Adolescent Idiopathic Scoliosis (AIS) (Cobb Angle ≥90°)

The Role of a Dual Attending Surgeon Strategy

Kwan, Mun Keong, MBBS, MSOrth; Chiu, Chee Kidd, MBBS, MSOrth; Hasan, Mohd Shahnaz, MBBS, MAnes; Tan, Shun Herng, MBBS; Loh, Ling Hui, MBBS; Yeo, Kye Sheng, MBBS; Lee, Wei Hong, MBBS; Chan, Chris Yin Wei, MD, MSOrth

doi: 10.1097/BRS.0000000000002848

Study Design. Retrospective study.

Objective. To evaluate the perioperative outcome of dual attending surgeon strategy for severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle more than or equal to 90°.

Summary of Background Data. The overall complication rate for AIS remains significant and is higher in severe scoliosis. Various operative strategies had been reported for severe scoliosis. However the role of dual attending surgeon strategy in improving the perioperative outcome in severe scoliosis has not been investigated.

Methods. The patients were stratified into two groups, Cobb angles 90° to 100° (Group 1) and more than 100° (Group 2). Demographic, intraoperative, preoperative, and postoperative day 2 data were collected. The main outcome measures were intraoperative blood loss, use of allogeneic blood transfusion, operative time, duration of hospital stay postsurgery, and documentation of any perioperative complications.

Results. Eighty-five patients were recruited. The mean age for the whole cohort was 16.2 ± 5.2 years old. The mean age of Group 1 was 16.7 ± 5.7 and Group 2 was 15.6 ± 4.8 years old. The majority of the patients in both groups were Lenke 2 curves with the average Cobb angle of 93.9 ± 3.0° in Group 1 and 114.2 ± 10.2° in Group 2. The average operative time was 198.5 ± 47.5 minutes with an average blood loss of 1699.5 ± 939.3 mL. The allogeneic blood transfusion rate was 17.6%. The average length of stay postoperation was 71.6 ± 22.5 hours. When comparing the patients between Group 1 and Group 2, the operating time, total blood loss, allogeneic transfusion rate showed significant intergroup differences. Five complications were documented (one intraoperative seizure, one massive blood loss, one intraoperative loss of somatosensory evoked potential (SSEP) signal, and two superficial wound breakdown).

Conclusion. Dual attending surgeon strategy in severe AIS more than or equal to 90° demonstrated an average operative time of 199 minutes, intraoperative blood loss of 1.7 L, postoperative hospital stay of 71.6 hours, and a complication rate of 5.9% (5/85 patients). Curves with Cobb angle more than 100° lead to longer operating time, greater blood loss, and allogeneic transfusion rate.

Level of Evidence: 4

The complication rate associated with severe scoliosis is known to be higher. Dual attending surgeon strategy in severe adolescent idiopathic scoliosis treated with single stage posterior spinal fusion shows reduced operating time, blood loss, and a shorter stay. Curves with Cobb angle more than 100° lead to longer operating time, greater blood loss, and more allogenic transfusion.

Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia

Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Address correspondence and reprint requests to Chris Yin Wei Chan, MD, MSOrth, Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; E-mail:

Received 30 May, 2018

Revised 15 July, 2018

Accepted 3 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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