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The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review

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Abstract

Purpose

To investigate, through a systematic review, the impact of the waiting time for Adolescent Idiopathic Scoliosis (AIS) surgical correction from the point of view of deformity evolution, treatment cost, and quality of life.

Methods

PubMed, Embase, LILACS, SciELO, Scopus, Web of Science, LIVIVO, and Cochrane Library databases were searched by two researchers to select the articles. The eligibility criteria were: Patients diagnosed with AIS with indication for surgical correction and submitted to waiting lists until treatment. The risks of bias were evaluated using the Risk Of Bias In Non-randomized Studies—Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to classify the level of the evidence for each outcome. The summary of the available evidence is presented in a narrative synthesis.

Results

Six observational studies were included. In a Canadian study, the primary outcome was the need for additional spine surgery in patients who had to wait more than three months due to spine deformity progression. American researchers presented a sample of premenarcheal and skeletally immature patients with AIS showing increased Cobb angle and attributed this to a six-month waiting for the surgical treatment. Another study included 177 patients with AIS with a mean waiting time of 225.7 days. There was a worsening average of 7.7° ± 8.6° in Cobb angle, and there was a change in surgical plan in 28 patients, which increased surgical time. Studies that evaluated the treatment cost showed significantly higher mean costs in those who waited longer than six months. Regarding the quality of life, while waiting for surgery, a retrospective study found that patients who underwent surgery earlier showed better results in a questionnaire that assessed their quality of life compared to those who were still waiting.

Conclusion

Observational studies show that, in individuals who are on waiting lists for AIS surgery, there is a worsening of the spinal deformity (substantial evidence), an increasing cost of treatment (moderate evidence) and it may negatively impact patients' quality of life (insufficient evidence). Performing better methodological quality studies to investigate these outcomes can violate good research practices since randomized clinical trials on this subject have ethical limitations to be carried out.

Trial registration

The authors declare that the systematic review protocol was registered at the international prospective register of systematic reviews (PROSPERO), CRD42020212134, and it was accepted for publication.

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Funding

The project was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), process 442639/2019–8. CNPq/MS/SCTIE/Decit number 27/2019–Research to strengthen the objectives and guidelines of the Care Network for People with Disabilities within the scope of the Unified Health System (SUS). Thematic line 3: Assessment of the health of people with Adolescent Idiopathic Scoliosis (AIS) and its repercussions for the Unified Health System.

Author information

Authors and Affiliations

  1. Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, 11 Floor - Vila Monte Alegre - CEP 14048-900, Ribeirão Preto, SP, Brazil

    Mariana Demétrio de Sousa Pontes, Thabata Pasquini Soeira & Carlos Fernando Pereira da Silva Herrero

  2. University of Ribeirão Preto, Ribeirão Preto, SP, Brazil

    Mariangela Louzada Sampaio

  3. Hospital Do Servidor Público Estadual, São Paulo, SP, Brazil

    Raphael de Rezende Pratali

  4. Hospital for Special Surgery, New York, NY, USA

    Yuri Pompeu

Authors
  1. Mariana Demétrio de Sousa Pontes
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  2. Thabata Pasquini Soeira
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  3. Mariangela Louzada Sampaio
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  4. Raphael de Rezende Pratali
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  5. Yuri Pompeu
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  6. Carlos Fernando Pereira da Silva Herrero
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Corresponding author

Correspondence to Mariana Demétrio de Sousa Pontes.

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Appendices

Appendix A Detailing the search strategies

  • MEDLINE (via PubMed): 1164 studies

((wait* time) OR (wait* list) OR (delay* surgery) OR (late surgery)) AND ((scoliosis) OR (idiopathic scoliosis) OR (adolescent idiopathic scoliosis) OR (AIS)).

  • Embase: 62 studies

((wait* time) OR (wait* list) OR (delay* surgery)) AND (scoliosis).

  • LILACS: 8 studies

((waiting) OR (wait) OR (delay) OR (delaying)) AND (scoliosis).

  • SciELO: 6 studies

((wait*) OR (delay*)) AND (scoliosis).

  • Scopus: 258 studies

((wait*) OR (delay*)) AND (idiopathic scoliosis).

  • Web of Science: 5527 studies

((wait* time) OR (wait* list) OR (delay* surgery) OR (late surgery)) AND ((scoliosis) OR (idiopathic scoliosis) OR (adolescent idiopathic scoliosis) OR (AIS)).

  • LIVIVO: 265 studies

((wait*) OR (delay*)) AND (idiopathic scoliosis).

  • Cochrane Library: 606 studies

(adolescent idiopathic scoliosis).

  • Google Scholar: 2790 studies

((wait* time) OR (wait* list) OR (delay* surgery) OR (late surgery)) AND ((scoliosis) OR (idiopathic scoliosis) OR (adolescent idiopathic scoliosis) OR (AIS)).

  • ClinicalTrials.gov: 211 studies

(idiopathic scoliosis).

  • OpenGrey: 48 studies

(scoliosis).

Appendix B: Data extraction form

01) General information:

  • Title.

  • Authors.

  • Year of Publication.

  • Publication Format.

  • Country of Origin.

  • Study Design.

  • Place of Publication

02) Participants:

  • Age.

  • Sex.

03) Methodologies:

  • Goals.

  • Study Variables.

  • Randomization Techniques.

  • Intervention Techniques.

  • Control.

04) Results:

  • Number of Patients.

  • Measuring Tools.

  • Follow-up Time.

  • Waiting time for surgery.

  • Cobb angle at the time of registration in the waiting list.

  • Preoperative Cobb angle.

  • Change in surgical planning.

  • Quality of life assessment.

  • Cost assessment.

  • Statistical tests.

05) Other descriptors

06) Conclusions

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Pontes, M.D.d., Soeira, T.P., Sampaio, M.L. et al. The impacts of waiting for surgical correction of Adolescent Idiopathic Scoliosis and its repercussions for publicly funded health systems: systematic review. Eur Spine J 32, 617–624 (2023). https://doi.org/10.1007/s00586-022-07487-2

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