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Inpatient versus outpatient halo-gravity traction in children with severe spinal deformity
Nestor Ricardo Davies1, Victor Vasquez Rodriguez2, Rodrigo German Remondino2
1Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881, C1245AAM, Ciudad Autónoma de Buenos Aires (CABA), Argentina. daviesricardo@hotmail.com.
Insights
Preoperative halo-gravity traction for severe spinal deformities is effective in both inpatient and outpatient settings. Outpatient care offers a comparable alternative with significantly lower treatment costs.
Area of Science:
- Orthopedics
- Spine Surgery
- Pediatric Deformity Correction
Background:
- Severe spinal deformities necessitate complex surgical management.
- Preoperative halo-gravity traction can reduce surgical invasiveness and improve patient parameters.
- Comparing inpatient vs. outpatient traction is crucial for optimizing care.
Purpose of the Study:
- To compare outcomes, complications, and costs of preoperative halo-gravity traction.
- To evaluate the feasibility of outpatient halo-gravity traction for pediatric spinal deformities.
Main Methods:
- Retrospective comparative study of 29 patients (<18 years) with kyphoscoliosis.
- Patients divided into inpatient (n=15) and outpatient (n=14) groups.
- Comparison of traction time, weight, curve correction, complications, and costs.
Main Results:
- Similar radiographic correction (coronal & sagittal) in both groups.
- Comparable complication rates (pin loosening, infection, neurologic issues).
- Inpatient care was 2.8 times more costly than outpatient care.
Conclusions:
- Outpatient halo-gravity traction is a viable option for managing severe spinal deformities.
- Offers comparable efficacy to inpatient care with significant cost savings.
- Supports considering outpatient settings for halo-gravity traction to optimize resource utilization.
Study Design:
A retrospective, comparative study.
Objective:
To compare the results, complications, and costs of preoperative halo-gravity traction in in- and outpatient settings.
Background Data:
Surgical management of severe spinal deformities remains complex and controversial. Preoperative halo-gravity traction results in a decreased need for aggressive surgical techniques, lower incidence of intraoperative neurologic complications, and improvement of nutritional parameters and preoperative cardiopulmonary function.
Methods:
Twenty-nine patients younger than 18 years with kyphoscoliosis undergoing preoperative halo-gravity traction were divided into two groups: inpatients (n: 15) and outpatients (n: 14, home care or care at the Foundation). Traction time (weeks), traction weight (kg), radiographic curve correction, complications, and costs were compared. For statistical analysis, t test and odds ratio were calculated with a significance of p < 0.05.
Results:
Mean traction time was 6 weeks for in- and 4 weeks for outpatients (p = 0.038). Initial traction weight was 6 kg in both groups, while final traction weight was 13 kg for in- and 15 kg for outpatients (p = 0.50). At the end of the traction period, coronal correction was 24° in in- and 28° in outpatients (p = 0.5), while sagittal correction was 27° and 29°, respectively (p = 0.80). Pin loosening was observed in 2 patients in each group, of whom 1 outpatient developed pin-site infection. In each group, one patient developed transient neurologic complications (odds ratio 1.091). Mean treatment cost per patient was 2.8-fold higher in inpatients.
Conclusions:
Considering complications and costs, our results show that preoperative halo-gravity traction in an outpatient setting is an option to be taken into account.
Level Of Evidence:
Grade III.
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