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Article: The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?

TitleThe Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?
Authors
KeywordsDisease severity
Adolescent idiopathic scoliosis
Operative treatment outcomes
International
Operative complications
Issue Date2019
PublisherSpringer. The Journal's web site is located at https://www.springer.com/journal/43390
Citation
Spine Deformity, 2019, v. 7 n. 6, p. 883-889 How to Cite?
AbstractBackground: 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.
Persistent Identifierhttp://hdl.handle.net/10722/288125
ISSN
2023 Impact Factor: 1.6
2023 SCImago Journal Rankings: 0.798
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorToombs, C-
dc.contributor.authorLonner, B-
dc.contributor.authorFazal, A-
dc.contributor.authorBoachie-Adjei, O-
dc.contributor.authorBastrom, T-
dc.contributor.authorPellise, F-
dc.contributor.authorMohamed Ramadan, M-
dc.contributor.authorKoptan, W-
dc.contributor.authorElMiligui, Y-
dc.contributor.authorZhu, F-
dc.contributor.authorQiu, Y-
dc.contributor.authorShufflebarger, H-
dc.date.accessioned2020-10-05T12:08:14Z-
dc.date.available2020-10-05T12:08:14Z-
dc.date.issued2019-
dc.identifier.citationSpine Deformity, 2019, v. 7 n. 6, p. 883-889-
dc.identifier.issn2212-134X-
dc.identifier.urihttp://hdl.handle.net/10722/288125-
dc.description.abstractBackground: 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.-
dc.languageeng-
dc.publisherSpringer. The Journal's web site is located at https://www.springer.com/journal/43390-
dc.relation.ispartofSpine Deformity-
dc.rightsThis is a post-peer-review, pre-copyedit version of an article published in [insert journal title]. The final authenticated version is available online at: https://doi.org/[insert DOI]-
dc.subjectDisease severity-
dc.subjectAdolescent idiopathic scoliosis-
dc.subjectOperative treatment outcomes-
dc.subjectInternational-
dc.subjectOperative complications-
dc.titleThe Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?-
dc.typeArticle-
dc.identifier.emailZhu, F: aaronzhu@hku.hk-
dc.identifier.authorityZhu, F=rp02301-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jspd.2019.04.004-
dc.identifier.pmid31731998-
dc.identifier.scopuseid_2-s2.0-85065913990-
dc.identifier.hkuros315442-
dc.identifier.volume7-
dc.identifier.issue6-
dc.identifier.spage883-
dc.identifier.epage889-
dc.identifier.isiWOS:000671884300006-
dc.publisher.placeGermany-
dc.identifier.issnl2212-134X-

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