What are parents willing to accept? A prospective study of risk tolerance in AIS surgery



Surgical treatment of Adolescent Idiopathic Scoliosis (AIS) involves healthy individuals with spinal deformity. Parents are responsible for surgical consent on behalf of their children, a burden which causes trepidation and concern. Therefore, explanation of operative risk is a critical component of informed consent and parent decision-making. We set out to quantify parental risk aversion (RA).


RA questionnaires were administered preoperatively to parents of 58 AIS patients undergoing spinal fusion (SF). RA is the likelihood of a parent to consent to their child’s SF (1- least likely, 10- most) with increasing allotments of data about potential complications at each stage (S1-complication named, S2-explained, S3-incidence given, S4-all information). A statistically significant mean difference in answers for each stage was assessed using paired sample t test or Wilcoxon rank t test. Normality was assessed by performing Shapiro–Wilk test.


AIS patients (age 14.2 years, 85% female, major curve 61°) were included. Mean scores for each of the stages were 4.4 ± 3.1, 4.9 ± 3.1, 6.5 ± 3.0, 6.6 ± 3.0, respectively. Highest and lowest RA were reported for death and infection, respectively. The greatest increase in likelihood to proceed with surgery was seen after education on malposition of implants and on death, 2.6 and 2.5, respectively (p < 0.001). The lowest increase in likelihood to proceed with surgery was seen after education on infection, 1.5 (p < 0.001). For all complications, there was an increase in parent willingness to proceed after providing descriptions and occurrence rate with a mean increase from S1 to S4 of 2.1 (95% CI 1.4–2.4), p < 0.001.


As more detailed information was made available regarding potential complications with SF for AIS, parental RA toward surgery decreased and their willingness to proceed with surgery for their child improved.

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This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet. Harms Study Group Investigators are, Aaron Buckland, MD; New York University. Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia. Amit Jain, MD; Johns Hopkins Hospital. Baron Lonner, MD; Mount Sinai Hospital. Benjamin Roye, MD; Columbia University. Burt Yaszay, MD; Rady Children’s Hospital. Chris Reilly, MD; BC Children’s Hospital. Daniel Hedequist, MD; Boston Children’s Hospital. Daniel Sucato, MD; Texas Scottish Rite Hospital. David Clements, MD; Cooper Bone and Joint Institute New Jersey. Firoz Miyanji, MD; BC Children’s Hospital. Harry Shufflebarger, MD; Nicklaus Children's Hospital. Jack Flynn, MD; Children’s Hospital of Philadelphia. Jahangir Asghar, MD; Cantor Spine Institute. Jean Marc Mac Thiong, MD; CHU Sainte-Justine. Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia. Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad. Keith Bachmann, MD; University of Virginia. Larry Lenke, MD; Columbia University. Mark Abel, MD; University of Virginia. Michael Glotzbecker, MD; Boston Children’s Hospital. Michael Kelly, MD; Washington University. Michael Vitale, MD; Columbia University. Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation. Munish Gupta, MD; Washington University. Nicholas Fletcher, MD; Emory University. Patrick Cahill, MD; Children’s Hospital of Philadelphia. Paul Sponseller, MD; Johns Hopkins Hospital. Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children. Peter Newton, MD; Rady Children’s Hospital. Peter Sturm, MD; Cincinnati Children’s Hospital. Randal Betz, MD; Institute for Spine and Scoliosis. Ron Lehman, MD; Columbia University. Stefan Parent, MD: CHU Sainte-Justine. Stephen George, MD; Nicklaus Children's Hospital. Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia. Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children. Tom Errico, MD; Nicklaus Children's Hospital. Vidyadhar Upasani, MD; Rady Children’s Hospital.


Grant funding from SRS, AAOS, and the Harms Study Group.

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Contributed to conception or design of work; or the acquisition, analysis, or interpretation of data for the work: BL, AJ, PS, LE, AS, MK, AC, MM, CA, SS. Drafting of the manuscript: BL, AJ, PS, LE, AS, MK, AC, MM, CA, SS. Revision for important intellectual content: BL, AJ, PS, LE, AS, MK, AC, MM, CA, SS. Approved final version of paper: BL, AJ, PS, LE, AS, MK, AC, MM, CA, SS.

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Correspondence to Baron Lonner.

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The members of the Harms Study Group Investigators are listed in acknowledgements.

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Lonner, B., Jain, A., Sponseller, P. et al. What are parents willing to accept? A prospective study of risk tolerance in AIS surgery. Spine Deform (2020). https://doi.org/10.1007/s43390-020-00216-z

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  • Risk aversion
  • Adolescent idiopathic scoliosis
  • Spinal fusion