Cumulative Anesthesia Exposure in Patients Treated for Early-Onset Scoliosis

Early-onset scoliosis (EOS) is a potentially life-threatening condition that requires early intervention to prevent severe deformity and pulmonary compromise. Observational studies have demonstrated that children receiving multiple procedures requiring general anesthesia are at a higher risk for adverse neurocognitive outcomes. We sought to characterize anesthetic exposure in EOS patients and to determine risk factors for increased exposure. We hypothesized that patients treated for EOS were at risk of receiving large amounts of cumulative anesthesia in childhood because of the need for early intervention to preserve pulmonary function. We sought to determine which factors impacted the amount of anesthesia patients received over the course of treatment.

Records of all EOS patients treated at a tertiary referral center from 2000 to 2014 were reviewed. Patients with a minimum two-year follow-up, under age 10 at diagnosis, were included. Anesthesia was recorded in three categories: 1) orthopedic surgeries; 2) nonorthopedic surgeries; and 3) imaging/associated procedures. Diagnoses included congenital, idiopathic, neuromuscular, and syndromic scoliosis. Treatment groups were: observation, bracing, Mehta casting, growing spine, or fusion.

Mean cumulative anesthesia time was 1606 minutes. Patients with neuromuscular (mean 2132 minutes, p = .006) or congenital scoliosis (1875 minutes, p < .001) received more anesthesia than those with idiopathic scoliosis (754 minutes). Patients treated by fusion (2036 minutes, p < .001) or growing spine (2855 minutes, p < .001) received more anesthesia than those treated by bracing.

Disease severity, non-idiopathic diagnoses, and longer length of follow-up were associated with increased anesthesia. Patients who presented at earlier ages, and those treated by Mehta casting, were more likely to exceed three hours of anesthesia prior to age 3.

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