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Original Research

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Perioperative characteristics and predictors of intensive care needs in patients undergoing surgery for scoliosis: a retrospective study of 165 patients

  • Shamsiya Mahammadova1
  • Sibel Oba1,*,
  • Ayşe Surhan Çinar1
  • Hacer Şebnem Türk1
  • Hacı Mustafa Özdemı̇r2

1Department of Anaesthesiology and Reanimation, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, 34396 Istanbul, Turkey

2Department of Orthopaedics and Traumatology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, 34396 Istanbul, Turkey

DOI: 10.22514/sv.2023.121 Vol.20,Issue 2,February 2024 pp.46-52

Submitted: 05 July 2023 Accepted: 29 August 2023

Published: 08 February 2024

*Corresponding Author(s): Sibel Oba E-mail: sibel.oba@sbu.edu.tr

Abstract

In this study, we retrospectively performed a review of medical records of all patients who underwent scoliosis surgery between January 2018 and January 2021. A total of 165 patients were included; (64.2% were female and the mean age was 21.6 ± 16.7 years). The most frequent aetiologies of scoliosis were idiopathic, congenital, degenerative and neuromuscular. In 48 patients who required Intensive Care Unit (ICU) stay, the rate of comorbidity was 75% (n = 36); lung disease was present in 54% (n = 26) of cases and restrictive lung disease was present in 47.9% of cases (n = 23), which were significantly higher than those who did not require ICU stay (p < 0.001). The proportion of patients with neuromuscular problems was 45.8% (n = 22) (p = 0.004) while those with epilepsy was 16.7% (n = 8) (p = 0.027). The proportion of patients with neuromuscular scoliosis was 25% (n = 12), the median number of fused vertebrae (fusion level) was 15, and the proportion of American Society of Anaesthesiologists (ASA) III patients was 54.2%(n = 26) (all p < 0.001). The median surgical duration was 307.5 minutes (p = 0.006) and the proportion of patients which received blood transfusion was 91.7% (n = 44) (p = 0.002). The pre- and post-operative haemoglobin (Hb) levels, and the post-operative arteriel blood gases (ABG) potential of hydrogen (pH) and lactate levels of patients, who needed ICU were significantly different from those who did not require the ICU (p = 0.043, p = 0.039, p < 0.001 and p = 0.037). In conclusion, a presence of restrictive lung disease, epilepsy, neuromuscular scoliosis, a high fusion level, a need for blood transfusion, long surgical duration, low Hb and pH values, and high lactate levels were found as the predictors of ICU admission.


Keywords

Intensive care unit; Perioperative characteristics; Scoliosis; Spine; Surgery


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Shamsiya Mahammadova,Sibel Oba,Ayşe Surhan Çinar,Hacer Şebnem Türk,Hacı Mustafa Özdemı̇r. Perioperative characteristics and predictors of intensive care needs in patients undergoing surgery for scoliosis: a retrospective study of 165 patients. SignaVitae. 2024. 20(2);46-52.

References

[1] Hengartner AC, Havlik J, David WB, Reeves BC, Freedman IG, Sarkozy M, et al. Association between intravenous to oral opioid transition time and length of hospital stay after posterior spinal fusion for adolescent idiopathic scoliosis. International Journal of Spine Surgery. 2023; 17: 468–476.

[2] Pico J, Sola C, Saour AC, Chapron K, Coruble L, Bringuier S, et al. Enhanced recovery after surgery (ERAS) for adolescent idiopathic scoliosis: Standardisation of care improves patient outcomes. Anaesthesia Critical Care & Pain Medicine. 2022; 41: 101116.

[3] Hudec J, Prokopová T, Kosinová M, Gál R. Anesthesia and perioperative management for surgical correction of neuromuscular scoliosis in children: a narrative review. Journal of Clinical Medicine. 2023; 12: 3651.

[4] Antolovich GC, Cooper MS, Johnson MB, Lundine K, Yang Y, Frayman K, et al. Perioperative care of children with severe neurological impairment and neuromuscular scoliosis—a practical pathway to optimize peri-operative health and guide decision making. Journal of Clinical Medicine. 2022; 11: 6769.

[5] Julien-Marsollier F, Penisson L, Happiette A, Ilharreborde B. Can hydroxyapatite charged collagen sponge help reduce perioperative blood loss in adolescent idiopathic scoliosis surgery? Preliminary results in 68 patients. European Spine Journal. 2023; 32: 883–888.

[6] Buhl LK, Bastos AB, Pollard RJ, Arle JE, Thomas GP, Song Y, et al. Neurophysiologic intraoperative monitoring for spine surgery: a practical guide from past to present. Journal of Intensive Care Medicine. 2021; 36: 1237–1249.

[7] Kay HF, Chotai S, Wick JB, Stonko DP, McGirt MJ, Devin CJ. Preoperative and surgical factors associated with postoperative intensive care unit admission following operative treatment for degenerative lumbar spine disease. European Spine Journal. 2016; 25: 843–849.

[8] Helenius L, Gerdhem P, Ahonen M, Syvänen J, Jalkanen J, Charalampidis A, et al. Postoperative outcomes of pedicle screw instrumentation for adolescent idiopathic scoliosis with and without a subfascial wound drain: a multicentre randomized controlled trial. The Bone & Joint Journal. 2022; 104-B: 1067–1072.

[9] Tang CYK, Kamath VHD, Cheung PWH, Cheung JPY. Predictive factors for intraoperative blood loss in surgery for adolescent idiopathic scoliosis. BMC Musculoskeletal Disorders. 2021; 22: 225.

[10] Cristante AF, Borges PA, Barbosa AR, Letaif OB, Marcon RM, Barros-Filho TE. Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis. Clinics. 2014; 69: 672–676.

[11] Yu X, Xiao H, Wang R, Huang Y. Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine. 2013; 38: 350–355.

[12] Somani S, Capua JD, Kim JS, Phan K, Lee NJ, Kothari P, et al. ASA classification as a risk stratification tool in adult spinal deformity surgery: a study of 5805 patients. Global Spine Journal. 2017; 7: 719–726.

[13] Shaw KA, Harris H, Sachwani N, Ruska T, Murphy JS, Fletcher ND. Avoiding PICU admission following PSF for neuromuscular scoliosis in non-ambulatory cerebral palsy managed with ERAS protocol. Spine Deformity. 2023; 11: 671–676.

[14] Sciubba D, Jain A, Kebaish KM, Neuman BJ, Daniels AH, Passias PG, et al. Development of a preoperative adult spinal deformity comorbidity score that correlates with common quality and value metrics: length of stay, major complications, and patient-reported outcomes. Global Spine Journal. 2021; 11: 146–153.

[15] Kanda Y, Kakutani K, Egi M, Zhang Z, Yurube T, Takeoka Y, et al. Preoperative base excess as a predictor of perioperative complications in patients with nonidiopathic scoliosis who have high risk associated with general anesthesia. Spine Surgery and Related Research. 2022; 7: 268–275.

[16] Guay J, Haig M, Lortie L, Guertin MC, Poitras B. Predicting blood loss in surgery for idiopathic scoliosis. Canadian Journal of Anaesthesia. 1994; 41: 775–781.

[17] Che L, Zhang XH, Li X, Zhang YL, Xu L, Huang YG. Outcome impact of individualized fluid management during spine surgery: a before-after prospective comparison study. BMC Anesthesiology. 2020; 20: 181.

[18] Anastasian ZH, Gaudet JG, Levitt LC, Mergeche JL, Heyer EJ, Berman MF. Factors that correlate with the decision to delay extubation after multilevel prone spine surgery. Journal of Neurosurgical Anesthesiology. 2014; 26: 167–171.

[19] Shapiro F, Zurakowski D, Sethna NF. Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis. Spine. 2007; 32: 2278–2283.

[20] Kolz JM, Neal KM. Hidden blood loss in adolescent idiopathic scoliosis surgery. Orthopaedics & Traumatology: Surgery & Research. 2022; 108: 103216.

[21] Abu-Kishk I, Kozer E, Hod-Feins R, Anekstein Y, Mirovsky Y, Klin B, et al. Pediatric scoliosis surgery—is postoperative intensive care unit admission really necessary? Pediatric Anesthesia. 2013; 23: 271–277.

[22] Özçelik M, Özalp Ş, Kalem M, Bermede O, Yazar T, Ökten F, et al. Postoperative complications in patients undergoing scoliosis surgery. Turkiye Klinikleri Journal of Anesthesiology Reanimation. 2017; 15: 24–30.

[23] Zhang XN, Sun XY, Meng XL, Hai Y. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. International Orthopaedics. 2018; 42: 2603–2612.

[24] Soini V, Raitio A, Helenius I, Helenius L, Syvänen J. A retrospective cohort study of bleeding characteristics and hidden blood loss after segmental pedicle screw instrumentation in neuromuscular scoliosis as compared with adolescent idiopathic scoliosis. North American Spine Society Journal. 2022; 12: 100190.

[25] Malik AT, Yu E, Kim J, Khan SN. Intensive care unit admission following surgery for pediatric spinal deformity: an analysis of the ACS-NSQIP pediatric spinal fusion procedure targeted dataset. Global Spine Journal. 2020; 10: 177–182.

[26] White KK, Bompadre V, Krengel WF, Redding GJ. Low preoperative lung functions in children with early onset scoliosis predict postoperative length of stay. Journal of Pediatric Orthopaedics. 2021; 41: e316–e320.

[27] Smith JS, Saulle D, Chen CJ, Lenke LG, Polly DW Jr, Kasliwal MK, et al. Rates and causes of mortality associated with spine surgery based on 108,419 procedures. Spine. 2012; 37: 1975–1982.

[28] Shaffrey E, Smith JS, Lenke LG, Polly DW Jr, Chen CJ, Coe JD, et al. Defining rates and causes of mortality associated with spine surgery: comparison of 2 data collection approaches through the scoliosis research society. Spine. 2014; 39: 579–586.


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