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Do We Need Postoperative Chest Radiographs After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?

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Abstract

Study Design

The question was addressed in three ways: (1) a query of Kids’ Inpatient Database (KID) to obtain nationally representative data; (2) retrospective review of cases at a single institution; (3) survey of Scoliosis Research Society (SRS) spine surgeons.

Objectives

Evaluate the rate of immediate postoperative pulmonary complications, risk factors, and relevant surgeon practice patterns, to determine the usefulness of routine postoperative chest radiographs after posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS).

Summary of Background Data

Routine postoperative chest radiography after PSIF for AIS is performed in many institutions to evaluate for acute pulmonary complications, particularly pneumothorax (PTX). The incidence of pneumothorax and its effect on management is unknown.

Methods

The frequency of PTX and surgical intervention were recorded. We evaluated associations between PTX and patient demographics or comorbidities, as well as survey respondent demographics and their practice patterns.

Results

In the KID data sets, the risk of PTX after PSIF for AIS patients was 0.3% (30/9,036), with intervention required in 13.3% (4/30) of PTX-positive patients (0.04% of all cases). Review of cases at our institution revealed a PTX rate of 3.3% (8/244) by radiology report. No surgical intervention was required. Patients with PTX had, on average, an increased number of vertebrae fused (p = .012), a proximal thoracic scoliosis curve location (p = .009), and/or an intraoperative blood transfusion (p = .002). SRS respondents reported a PTX risk of 0.8% (87/11,318), and 32.2% (89/276) of respondents indicated routine use of postoperative chest radiographs. Of those, 46.1% (41/89) specified willingness to change practice patterns if provided evidence of low PTX rates.

Conclusions

Pneumothorax is uncommon after PSIF for AIS. The need for intervention is even less common. Routine postoperative chest radiographs are of questionable value after PSIF for AIS.

Level of Evidence

Level III.

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Authors and Affiliations

  1. School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294, USA

    Robert Esposito BS

  2. Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294, USA

    Michael Conklin MD & Shawn R. Gilbert MD

  3. Children’s of Alabama, 1600 7th Ave. S., Lowder Bldg., Suite 316, Birmingham, AL, 35233, USA

    Michael Conklin MD & Shawn R. Gilbert MD

  4. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL, 35294, USA

    Gerald McGwin MS, PhD

Authors
  1. Robert Esposito BS
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  2. Michael Conklin MD
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  3. Gerald McGwin MS, PhD
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  4. Shawn R. Gilbert MD
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Corresponding author

Correspondence to Shawn R. Gilbert MD.

Additional information

IRB approval: Principal investigator: Gilbert, Shawn R; Protocol Number X160325007; Protocol title: Adverse Pulmonary Events Following Posterior Spinal Fusion in Children; Approval date: May 11, 2017; IRB approval no longer valid on: May 3, 2019.

Funding sources: University of Alabama Department of Surgery.

Author disclosures: RE (grants from UAB Department of Surgery, during the conduct of the study), MC (none), GM (none), SG (none).

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Esposito, R., Conklin, M., McGwin, G. et al. Do We Need Postoperative Chest Radiographs After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?. Spine Deform 7, 571–576 (2019). https://doi.org/10.1016/j.jspd.2018.09.071

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  • DOI: https://doi.org/10.1016/j.jspd.2018.09.071

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