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Reduction in mortality in pediatric non-idiopathic scoliosis by implementing a multidisciplinary screening process
Lorenzo Deveza1, John Heydemann2,3, Mohit Jain4
1Baylor College of Medicine, Houston, TX, USA.
Insights
Implementing a multidisciplinary (Multi-D) conference significantly reduced 1-year mortality in pediatric patients undergoing spinal surgery for non-idiopathic scoliosis. This protocol improves safety and outcomes for complex spinal conditions.
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Scoliosis Research
Background:
- Pediatric patients with non-idiopathic scoliosis face higher complication rates during spinal instrumentation surgery compared to those with idiopathic scoliosis.
- Serious complications, including mortality, can occur in this vulnerable population.
- Multidisciplinary approaches have shown promise in reducing perioperative complications in adult spinal deformity, but evidence in pediatric cases is limited.
Purpose of the Study:
- To evaluate the impact of a multidisciplinary (Multi-D) screening protocol on complication rates in pediatric patients undergoing spinal instrumentation for non-idiopathic scoliosis.
- To compare outcomes before and after the implementation of a Neuromuscular Spine Surgery Care Plan.
Main Methods:
- A retrospective review of spinal instrumentation cases over four years (two years before and two years after July 2014) was conducted.
- The study included 129 cases (107 patients) pre-protocol and 122 cases (109 patients) post-protocol.
- Primary outcomes measured were 30-day and 1-year mortality, post-operative neurologic deficit, and surgical site infections (SSI).
Main Results:
- The Multi-D conference group had a higher Body Mass Index (BMI).
- Implementation of the Multi-D conference was associated with a significant reduction in 1-year mortality (4 vs 0, p=0.04) and a trend towards reduced 30-day mortality (2 vs 0, p=0.17).
- A reduction in post-operative neurologic deficit was also observed (2 vs 0, p=0.17), while SSI rates remained unchanged.
Conclusions:
- The implementation of a multidisciplinary (Multi-D) conference is an effective safety process for reducing serious complications, particularly mortality, following spinal instrumentation for non-idiopathic scoliosis in pediatric patients.
- This approach demonstrates significant benefits for managing complex pediatric spine conditions.
Study Design:
Retrospective comparative study.
Objectives:
To compare complications before and after implementation of the Multi-D screening protocol in complex pediatric patients undergoing spinal instrumentation for non-idiopathic scoliosis. Pediatric patients undergoing surgery for non-idiopathic scoliosis experience significantly more complications than those with idiopathic scoliosis. Operating on these patients can lead to serious complications including death. Recent reports have demonstrated the benefits of establishing a multidisciplinary-based system to reduce complications in adult spinal deformity during the perioperative period. However, there are limited studies examining these benefits in a complex pediatric spine population.
Methods:
This was a retrospective review of all cases involving spinal instrumentation at our institution for 2 years before and after the initiation of our Neuromuscular Spine Surgery Care Plan in July 2014. Study sample was n = 129 cases (107 patients) prior to the initiation of the process and n = 122 cases (109 patients) thereafter. Primary outcome measures included: mortality at 30 days and 1 year; post-operative neurologic deficit, and surgical site infections (SSI). Secondary outcome measures included: instrument failure in 1 year; readmission in 30 days; return to OR in 90 days.
Results:
The study populations were matched by age and gender. Patients passing the Multi-D conference had higher BMI. Implementation of the Multi-D conference reduced mortality at 30 days (2 vs 0, p = 0.17) and at 1 year (4 vs 0, p = 0.04), as well as reduced post-operative neurologic deficit (2 vs 0, p = 0.17). The rate of SSI remained unchanged. All other secondary outcome measures also remained unchanged.
Conclusions:
Implementation of a Multi-D conference led to a significant reduction in mortality at 1 year, and is an important safety process to reduce serious complications after non-idiopathic scoliosis surgery.
Level Of Evidence:
Level III.
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