Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 2nd Floor Wood Building, Philadelphia, PA, 19104, USA.
Spine Deform. 2021 Jul;9(4):1161-1167. doi: 10.1007/s43390-021-00285-8. Epub 2021 Jan 25.
Retrospective cohort study.
To determine if additional procedures can be safely performed under the same anesthesia as early-onset scoliosis (EOS) rib-based surgeries. EOS patients with rib-based implants often require repeated invasive surgery to treat their spinal deformity, with associated risks of cognitive development impairment from multiple anesthetic exposures. Many of these patients have comorbidities that require additional procedures, possibly increasing the risk of adverse outcomes.
We performed a retrospective review of EOS patients treated with rib-based implants with at least 2 year follow up at a single institution. Patients were divided into two cohorts: Group A included patients who never had another procedure in conjunction with a rib-based implant insertion, expansion, and/or revision surgery throughout their treatment and Group B included patients who had at least one other procedure operate in conjunction with rib-based implant surgery. Univariate analysis was performed to compare demographics, surgical parameters, and incidence of complication between the two groups. A subanalysis of patients who experienced an infection requiring surgery in Group A and Group B was also performed to further analyze the impact of concomitant procedures.
147 EOS patients underwent rib-based growing instrumentation at our institution. 98 patients (Group A) did not have another procedure occur under the same anesthetic as a rib-based implant surgery and 49 patients (Group B) had another procedure performed in conjunction with a rib-based implant surgery. Gender, etiology, BMI, length of follow up and number of rib-based implant procedures were similar between both cohorts (p = 0.91, 0.24, 0.28, 0.91, 0.77, respectively). The total surgical and anesthesia time was significantly longer in the patients undergoing concomitant procedures (Group B) (p < 0.0001, p < 0.0001, respectively). Among the patients in Group B, Otolaryngology was the most common department adding surgical care, followed by non-spine orthopaedics and general surgery. Mircrolaryngoscopy and bronchoscopy were performed most often (24 procedures), followed by cerumen removal under anesthesia (22 procedures), ear tube insertion (19 procedures) and bronchoscopy (19 procedures). Infection requiring irrigation and debridement was the most common complication found in both cohorts. Although Group B had a significantly lower number of patients who experienced complications (p = 0.002), the complication rate per procedure was 14% in Group A and 16% in Group B. When performing a subanalysis on patients who experienced an infection requiring irrigation and debridement surgery among Group A (47 patients) and Group B (8 patients), gender, etiology, BMI, length of follow up, and number of rib-based implant procedures were similar (p = 0.71, 0.26, 0.06, 0.69, 0.84 and, respectively). The total surgical and anesthesia time were similar (p = 0.11 and 0.13, respectively). In addition, the number of irrigation and debridement surgeries needed to treat each infection even was similar between the two groups (p = 0.59).
There was no difference in complication rate per procedure when other services operate in conjunction with rib-based implant surgery.
III.
回顾性队列研究。
确定在与早发性脊柱侧凸（EOS）肋骨基手术相同的麻醉下是否可以安全进行其他手术。肋骨基植入物的 EOS 患者通常需要多次侵入性手术来治疗脊柱畸形，这会因多次麻醉暴露而导致认知发育受损的风险。这些患者中有许多合并症需要额外的手术，这可能会增加不良后果的风险。
我们对在一家机构接受肋骨基植入物治疗且随访时间至少为 2 年的 EOS 患者进行了回顾性研究。患者分为两组：A 组患者在整个治疗过程中从未与肋骨基植入物插入、扩张和/或修订手术一起进行过其他手术；B 组患者至少有一次其他手术与肋骨基植入物手术一起进行。我们对两组患者的人口统计学、手术参数和并发症发生率进行了单变量分析。我们还对 A 组和 B 组中发生需要手术治疗感染的患者进行了亚组分析，以进一步分析伴随手术的影响。
我们机构共对 147 名 EOS 患者进行了肋骨基生长器械治疗。98 名患者（A 组）没有在与肋骨基植入物手术相同的麻醉下进行其他手术，49 名患者（B 组）有其他手术与肋骨基植入物手术一起进行。两组患者的性别、病因、BMI、随访时间和肋骨基植入物手术次数相似（p=0.91、0.24、0.28、0.91、0.77，分别）。同时进行手术的患者（B 组）的总手术和麻醉时间明显更长（p<0.0001、p<0.0001，分别）。在 B 组患者中，耳鼻喉科是最常见的附加手术科室，其次是非脊柱矫形科和普通外科。最常进行的手术包括鼻喉镜检查和支气管镜检查（分别为 24 次）、耳管插入（19 次）和支气管镜检查（19 次）。需要冲洗和清创的感染是两组中最常见的并发症。尽管 B 组发生并发症的患者比例显著较低（p=0.002），但 A 组的并发症发生率为 14%，B 组为 16%。对 A 组（47 名患者）和 B 组（8 名患者）中需要冲洗和清创手术治疗的感染患者进行亚组分析，发现两组患者的性别、病因、BMI、随访时间和肋骨基植入物手术次数相似（p=0.71、0.26、0.06、0.69、0.84，分别）。总手术和麻醉时间相似（p=0.11 和 0.13，分别）。此外，两组治疗每例感染所需的冲洗和清创手术次数也相似（p=0.59）。
当其他服务与肋骨基植入物手术同时进行时，每个手术的并发症发生率没有差异。
III。
