Surgeon Experience Does Not Change Rate of Perioperative Surgical Complication in Rib-Based Distraction Surgery for Early-Onset Scoliosis.

OBJECTIVE

To report on the surgical learning curve in treating early-onset scoliosis with rib-based distraction.

SUMMARY OF BACKGROUND DATA

The idea of a surgical learning curve proposes improved outcomes with experience. Early-onset scoliosis (EOS) is a challenging condition to treat and complication rates are high.

METHODS

All patients from a single experienced spine surgeon's practice who had undergone placement of rib-based distraction constructs between 2002 and 2013 were identified. A retrospective chart review was performed to determine patient characteristics at implantation and follow-up surgeries and complications. The primary outcome was complication rate per surgical encounter. Experience was analyzed both by number of surgical procedures and year in study period.

RESULTS

The surgeon began using rib-based distraction in 2002, and between 2002 and 2013, a total of 101 patients underwent 1,009 implantation or expansion surgeries involving rib-based distraction at a median age of 6 years at implantation (10 months-9.4 years). The median preoperative Cobb angle was 67° (8°-125°; IQR: 57°-76°) and follow-up was a median of 4.4 years (IQR 3.7-5.6 years). Overall, 65.3% of patients experienced complications, including 40 Grade I, 20 Grade II, 126 Grade IIA, and 3 Grade III. Univariate analysis identified a trend toward cumulative number of surgeries relating to a decreased complication rate, with every 50 surgeries decreasing the complication rate by 3% (p = .071). However, multivariate analysis found cumulative number of surgeries and complication rate to not be significantly related (p = .12). Surgeon experience as measured by study time (as both a continuous and categorical predictor) did not achieve statistical significance in either the univariate or multivariate models.

CONCLUSION

This is the largest single-surgeon series of EOS patients treated with rib-based distraction. Surgeon experience defined either as number of procedures or years of experience within the study period did not impact the rate of complications.