Characterizing Anesthetic Management and Perioperative Outcomes Associated with a Novel, Fusionless Scoliosis Surgery in Adolescents

• Published in: AANA journal Vol. 87; no. 5; pp. 404 - 410
• Main Authors: Chen, Erdong, Sites, Brian D, Rubenberg, Lisa A, Meador, Grant D, Braun, John T, Schroeck, Hedwig
• Format: Journal Article
• Language: English
• Published: United States AANA Publishing, Inc 01.10.2019
• Subjects: Adolescent; Adolescent Health Services; Anesthesia; Anesthesia, General; Child; Cohort Studies; Dimensional analysis; Families & family life; Female; Hospitals; Humans; Ligaments; Lumbar Vertebrae; Male; Narcotics; Nurse Anesthetists; Nursing; Pain management; Pain, Postoperative - prevention & control; Patients; Pediatrics; Retrospective Studies; Scoliosis; Scoliosis - nursing; Scoliosis - surgery; Spinal Fusion - methods; Surgeons; Surgery; Surgical outcomes; Teenagers; Treatment Outcome; Young Adult; anterior vertebral tethering; pediatric anesthesia; posterior spinal fusion; perioperative management; Adolescent idiopathic scoliosis
• ISSN: 0094-6354; 2162-5239

Anterior vertebral tethering (AVT) is a novel "fusionless" surgical approach to correct scoliosis. This study aims to characterize the anesthetic management and perioperative outcomes of AVT and traditional posterior spinal fusion (PSF) after establishing the technique at our institution. Scoliosis correction procedures performed in patients aged 10 to 21 years between January 2014 and August 2017 were identified in the electronic medical record. Patient characteristics and perioperative data about anesthetic use and pain management were extracted. Descriptive statistics were generated. Thirty-five patients undergoing AVT and 40 patients undergoing PSF met inclusion criteria. Preoperative fluoroscopy-guided epidural placement was used only in the AVT group (86%). The worst pain score on postoperative day (POD) 1 after AVT was a mean (SD) of 5.6 (2.3), with average pain scores on subsequent days ranging from 2.9 (1.2) to 3.6 (1.7). Total in-hospital opioid consumption in morphine milligram equivalents was 70 (76.6) for AVT and 193.4 (137.2) for PSF (P < .01). Discharge occurred on POD 4.4 (1.4) for AVT and POD 6.2 (1.9) for PSF (P < .01). The worst pain score on POD 1 for PSF was 6.6 (2.1), and average pain scores ranged from 3.7 (1.8) to 4.2 (1.8). These results help inform about the expected recovery profile and narcotic requirement after AVT and PSF.