Abstract
Background
The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort.
Methods
This is a retrospective study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications.
Results
Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%).
Conclusions
Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment.
Level of Evidence
Level II.
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Author disclosures: CT (none), BL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, John and Marcella Fox Fund Grant, and Orthopaedic Research and Education Foundation [OREF]; personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, Ethicon, Zimmer Biomet, Apifix, and Unyq Align; nonfinancial support from Spine Deformity journal, outside the submitted work), AF (none), OBA (grants, personal fees, and other from K2M; other from WEIGAO, outside the submitted work), TB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), FP (personal fees from DePuy Synthes Spine; grants from DePuy Synthes Spine, Medtronic, and Zimmer-Biomet, outside the submitted work), MR (none), WK (none), YE (none), FZ (none), YQ (none), HS (personal fees and royalties from DePuy Synthes and K2M).
Funding: Grant from DePuy Spine to Setting Scoliosis Straight Foundation in support of the Harms Study Group’s research.
IRB Approval: Institutional review board approval was obtained for this study from the NYU Langone Medical Center IRB on behalf of the study group.
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Toombs, C., Lonner, B., Fazal, A. et al. The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?. Spine Deform 7, 883–889 (2019). https://doi.org/10.1016/j.jspd.2019.04.004
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DOI: https://doi.org/10.1016/j.jspd.2019.04.004