Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA.
Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA.
Spine J. 2019 Feb;19(2):314-320. doi: 10.1016/j.spinee.2018.05.033. Epub 2018 May 23.
Early-onset scoliosis is a challenging problem that is defined as a curvature of the spine of more than 10 degrees identified in a child less than 10 years. Early-onset idiopathic scoliosis (EOIS) can cause substantial morbidity and may require surgical intervention.
The aim of the present study was to identify the trends of EOIS type of surgeries, length of hospital stay, in-hospital complications, and total inpatient admission charges over a 15-year study period in the United States from 1997 to 2012.
STUDY DESIGN/SETTING: This retrospective study used the ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes from the Healthcare Cost and Utilization Project (HCUP) Kids Inpatient's Database (KID) for a 15-year period (1997-2012).
We identified a total of 897 patients with EOIS over the 15-year study period.
The present study determines the current trends for EOIS surgeries.
The present study had no funding sources or any potential conflicts of interest associated biases. Idiopathic scoliosis patients with ages between 0 and <10 years were identified from the Kids' Inpatient Database with ICD-9-CM code 737.30. Posterior, anterior, and combined spinal surgeries were identified in EOIS through the procedure codes. Patients' gender, discharge diagnosis (comorbidities), hospital length of stay (LOS), mortality rates, hospital charges, and in-hospital complication rate data were collected between 1997 and 2012. The primary grouping variable of the study was the type of surgery (posterior, anterior, and combined). The trends of each variable (female gender, mortality rates, in-hospital complications rates, discharge diagnosis, LOS, and total hospital charges) were assessed for each surgical group separately. Cost inflation of hospital charges was adjusted for the year 2012. An analysis of variance test was used to analyze continuous variables and a chi-square test was used for categorical variables. A linear regression test was used to assess the trend of changes. p≤.05 was considered statistically significant.
The study identified 897 patients, with 546 (61%) of them requiring surgery. Spine deformity surgery rates significantly decreased in patients with EOIS over time from 75% in 1997 to 47% in 2012, p=.019. In the surgery cohort, the male to female distribution was 37% and 63%, respectively. The overall mortality rate was 0.1%. The average length of hospital stay was 8 days and the average number of discharge diagnosis was 5.3. Aggregated complications were seen in 6% of the patients. The total mean hospital charge (per 2012 US dollars) was $119,613, which increased significantly for all types of surgeries. Over the 15-year study period, 62% (n=342) of the patients had posterior surgeries, 13% (n=71) of the patients had anterior surgeries, and 24% (n=133) of the patients had combined (anterior and posterior) surgeries. Posterior surgeries increased significantly from 33% in 1997 to 91% in 2012 (p<.004). Combined surgeries saw a significant decline from 50% to 4.3% (0<0.001). Anterior surgeries also decreased from 17% to 4.3% (p<.126), but this did not reach statistical significance.
From 1997 to 2012 (15 years) study period of patients with EOIS, posterior-based surgeries significantly increased. The overall surgery rate has significantly decreased for these patients. A significant increase in hospital charges were noticed in posterior, anterior, and combined surgeries.
早发性脊柱侧凸是一个具有挑战性的问题，其定义为 10 岁以下儿童脊柱弯曲超过 10 度。早发性特发性脊柱侧凸（EOSIS）可能会导致严重的发病率，并可能需要手术干预。
本研究的目的是确定美国从 1997 年至 2012 年的 15 年研究期间 EOIS 手术类型、住院时间、住院并发症和总住院费用的趋势。
研究设计/设置：本回顾性研究使用了医疗保健成本和利用项目（HCUP）儿童住院数据库（KID）的 ICD-9-CM（国际疾病分类，第九修订版，临床修正）代码，时间跨度为 15 年（1997-2012）。
在 15 年的研究期间，我们共确定了 897 例 EOIS 患者。
本研究确定了 EOIS 手术的当前趋势。
本研究没有资金来源或任何与利益相关的潜在冲突。从儿童住院数据库中使用 ICD-9-CM 代码 737.30 确定年龄在 0 至<10 岁之间的特发性脊柱侧凸患者。通过手术代码确定 EOIS 中的后路、前路和联合脊柱手术。收集患者的性别、出院诊断（合并症）、住院时间（LOS）、死亡率、住院费用和住院并发症发生率数据，时间范围为 1997 年至 2012 年。研究的主要分组变量是手术类型（后路、前路和联合）。分别评估每个手术组中每个变量（女性性别、死亡率、住院并发症发生率、出院诊断、LOS 和总住院费用）的趋势。调整了 2012 年的医院费用通胀。使用方差分析检验分析连续变量，使用卡方检验分析分类变量。使用线性回归检验评估变化趋势。p≤.05 被认为具有统计学意义。
本研究确定了 897 例患者，其中 546 例（61%）需要手术。早发性脊柱侧凸患者脊柱畸形手术率随时间显著下降，从 1997 年的 75%降至 2012 年的 47%，p=.019。在手术组中，男女比例分别为 37%和 63%。总死亡率为 0.1%。平均住院时间为 8 天，平均出院诊断为 5.3 个。有 6%的患者出现了合并症。每例患者的总平均住院费用（以 2012 年美元计算）为 119613 美元，所有类型的手术费用均显著增加。在 15 年的研究期间，62%（n=342）的患者接受了后路手术，13%（n=71）的患者接受了前路手术，24%（n=133）的患者接受了前路和后路联合手术。后路手术从 1997 年的 33%显著增加到 2012 年的 91%（p<.004）。联合手术从 50%显著下降到 4.3%（0<0.001）。前路手术也从 17%下降到 4.3%（p<.126），但这没有达到统计学意义。
在 1997 年至 2012 年（15 年）早发性脊柱侧凸患者的研究期间，后路手术显著增加。这些患者的总体手术率显著下降。后路、前路和联合手术的住院费用显著增加。
