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Surgical Outcomes Research

Impact of Surgical Waiting-List Times on Scoliosis Surgery: The Surgeon’s Perspective

Miyanji, Firoz MD, FRCSC; Newton, Peter O. MD; Samdani, Amer F. MD; Shah, Suken A. MD; Varghese, Ranjit A. MBBS, MS, MHSc (Epi); Reilly, Christopher W. MD, FRCSC; Mulpuri, Kishore MBBS, MS, MHSc (Epi)

Study Design. Survey.

Objective. The aim of this study was to evaluate the surgeon’s perspective on the potential impact of prolonged surgical waitlists on the surgical care and perioperative management of patients with scoliosis.

Summary of Background Data. The long waits for surgical treatment of scoliosis found in some countries may have serious implications for the complexity of surgery and perioperative care required if the curve progresses while waiting. The surgeon’s perspective on this problem provides important information that needs to be taken into account during resource allocation.

Methods. Radiographs from 13 patients who had waited more than 6 months for scoliosis surgery were selected. Each patient had radiographs from the time of surgical booking and immediately preoperatively. The radiographs and a questionnaire were sent to 3 surgeons to canvass their surgical and postoperative plan. The surgeons were blinded to the fact that the radiographs were of the same patients at 2 time points. The patients’ actual course of treatment was documented.

Results. Data for 11 patients were available for analysis. The average wait for surgery was 24 months (range, 17–30 mo). The mean curve progression was 25.3° while on the waitlist, from an average of 52° to 77°. By the time the patients had to undergo surgery, more anterior releases were added to posterior instrumentation alone in the surgical plan. Mean estimated operative time increased by 2.2 hours, mean estimated length of hospital stay increased by 1 day, and the estimated level of difficulty of surgery increased 2.33 grades. The predicted estimated blood loss also increased.

Conclusion. From the surgeon’s perspective, lengthy waitlists have a significant negative impact on the perioperative and postoperative care of patients with scoliosis by increasing the complexity of surgery. The actual course of treatment corresponded to the responses from these different surgeons.

 

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Spine: 01 June 2015 – Volume 40 – Issue 11 – p 823–828

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