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Surgeon Experience Does Not Change Rate of Perioperative Surgical Complication in Rib-Based Distraction Surgery for Early-Onset Scoliosis

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Abstract

Objective

To report on the surgical learning curve in treating early-onset scoliosis with rib-based distraction.

Summary of Background Data

The idea of a surgical learning curve proposes improved outcomes with experience. Early-onset scoliosis (EOS) is a challenging condition to treat and complication rates are high.

Methods

All patients from a single experienced spine surgeon’s practice who had undergone placement of rib-based distraction constructs between 2002 and 2013 were identified. A retrospective chart review was performed to determine patient characteristics at implantation and follow-up surgeries and complications. The primary outcome was complication rate per surgical encounter. Experience was analyzed both by number of surgical procedures and year in study period.

Results

The surgeon began using rib-based distraction in 2002, and between 2002 and 2013, a total of 101 patients underwent 1,009 implantation or expansion surgeries involving rib-based distraction at a median age of 6 years at implantation (10 months–9.4 years). The median preoperative Cobb angle was 67° (8°–125°; IQR: 57°–76°) and follow-up was a median of 4.4 years (IQR 3.7–5.6 years). Overall, 65.3% of patients experienced complications, including 40 Grade I, 20 Grade II, 126 Grade IIA, and 3 Grade III. Univariate analysis identified a trend toward cumulative number of surgeries relating to a decreased complication rate, with every 50 surgeries decreasing the complication rate by 3% (p = .071). However, multivariate analysis found cumulative number of surgeries and complication rate to not be significantly related (p = .12). Surgeon experience as measured by study time (as both a continuous and categorical predictor) did not achieve statistical significance in either the univariate or multivariate models.

Conclusion

This is the largest single-surgeon series of EOS patients treated with rib-based distraction. Surgeon experience defined either as number of procedures or years of experience within the study period did not impact the rate of complications.

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References

  1. Williams BA, Matsumoto H, McCalla DJ, et al. Development and initial validation of the Classification of Early-Onset Scoliosis (CEOS). J Bone Joint Surg Am 2014;96:1359–67.

    Article  PubMed  Google Scholar 

  2. Davies G, Reid L. Effect of scoliosis on growth of alveoli and pulmonary arteries and on the right ventricle. Arch Dis Child 1971;46: 623–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Owange-Iraka JW, Harrison A, Warner JO. Lung function in congenital and idiopathic scoliosis. Eur J Pediatr 1984;142:198–200.

    Article  CAS  PubMed  Google Scholar 

  4. Campbell RM, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 2003;85(3):399–408.

    Article  PubMed  Google Scholar 

  5. Akbarnia BA, Marks DS, Boachie-Adjei O, et al. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine (Phila Pa 1976) 2005;30(17 suppl):S46–57.

    Article  Google Scholar 

  6. Akbarnia BA, Cheung K, Noordeen H, et al. Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine (Phila Pa 1976) 2013;38:665–70.

    Article  Google Scholar 

  7. Campbell RM, Smith MD, Mayes TC, et al. The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 2004;86:1659–74.

    Article  PubMed  Google Scholar 

  8. Emans JB, Caubet JF, Ordonez CL, et al. The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib. Spine (Phila Pa 1976) 2005;30(17 suppl):S58–68.

    Article  Google Scholar 

  9. McCarthy RE, Luhmann S, Lenke L, et al. The Shilla growth guidance technique for early-onset spinal deformities at 2-year followup: a preliminary report. J Pediatr Orthop 2014;34:1–7.

    Article  PubMed  Google Scholar 

  10. McCarthy RE, McCullough FL. Shilla growth guidance for early-onset scoliosis. J Bone Joint Surg Am 2015;97:1578–84.

    Article  PubMed  Google Scholar 

  11. Ramirez N, Flynn JM, Serrano JA, et al. The vertical expandable prosthetic titanium rib in the treatment of spinal deformity due to progressive early onset scoliosis. J Pediatr Orthop B 2009;18:197–203.

    Article  PubMed  Google Scholar 

  12. Thompson GH, Akbarnia BA, Campbell RM. Growing rod techniques in early-onset scoliosis. J Pediatr Orthop 2007;27:354–61.

    Article  PubMed  Google Scholar 

  13. Thompson W, Thakar C, Rolton DJ, et al. The use of magnetically-controlled growing rods to treat children with early-onset scoliosis. Bone Joint J 2016;98:1240–7.

    Article  PubMed  Google Scholar 

  14. Gofton WT, Papp SR, Gofton T, Beaulé PE Understanding and taking control of surgical learning curves. Instr Course Lect 2016;65:623–32.

  15. Gofton WT, Solomon M, Gofton T, et al. What do reported learning curves mean for orthopaedic surgeons? Instr Course Lect 2016;65:633–44.

    PubMed  Google Scholar 

  16. Guidry CA, Newhook TE, Turrentine FE, et al. Observations on surgeons’ case selection, morbidity, and mortality following board certification. Ann Surg 2016;263:487–92.

    Article  PubMed  Google Scholar 

  17. Guttmann D, Graham RD, MacLennan MJ, Lubowitz JH. Arthroscopic rotator cuff repair: the learning curve. Arthroscopy 2005;21: 394–400.

    Article  PubMed  Google Scholar 

  18. Hoogland T, van den Brekel-Dijkstra K, Schubert M, Miklitz B. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine (Phila Pa 1976) 2008;33:973–8.

    Article  Google Scholar 

  19. Jain NPM, Jowett AJL, Clarke NMP. Learning curves in orthopaedic surgery: a case for super-specialisation? Ann R Coll Surg Engl 2007;89:143–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. King J, Stamper DL, Schaad DC, Leopold SS. Minimally invasive total knee arthroplasty compared with traditional total knee arthroplasty—assessment of the learning curve and the postoperative recuperative period. J Bone Joint Surg Am 2007;89:497–503.

    Article  Google Scholar 

  21. Konan S, Rhee SJ, Haddad FS. Hip arthroscopy: analysis of a single surgeon’s learning experience. J Bone Joint Surg Am 2011;93(Suppl 2):52–6.

    Article  PubMed  Google Scholar 

  22. Lonner BS, Scharf C, Antonacci D, et al. The learning curve associated with thoracoscopic spinal instrumentation. Spine (Phila Pa 1976) 2005;30:2835–40.

    Article  Google Scholar 

  23. Nandyala SV, Fineberg SJ, Pelton M, et al. Minimally invasive transforaminal lumbar interbody fusion: one surgeon’s learning curve. Spine J 2014;14:1460–5.

    Article  PubMed  Google Scholar 

  24. Ryu KJ, Suh SW, Kim HW, et al. Quantitative analysis of a spinal surgeon’s learning curve for scoliosis surgery. Bone Joint J 2016;98:679–85.

    Article  PubMed  Google Scholar 

  25. Wang B, Lu G, Patel AA, et al. An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations. Spine J 2011;11:122–30.

    Article  PubMed  Google Scholar 

  26. Cahill PJ, Pahys JM, Asghar J, et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 2014;96:1333–9.

    Article  PubMed  Google Scholar 

  27. Lucas G, Bollini G, Jouve JL, et al. Complications in pediatric spine surgery using the vertical expandable prosthetic titanium rib—the French experience. Spine (Phila Pa 1976) 2013;38:E1589–99.

    Article  Google Scholar 

  28. Upasani VV, Miller PE, Emans JB, et al; Children’s Spine Study Group. VEPTR implantation after age 3 is associated with similar radiographic outcomes with fewer complications. J Pediatr Orthop 2016;36:219–25.

    Article  PubMed  Google Scholar 

  29. Bess S, Akbarnia BA, Thompson GH, et al. Complications of growing-rod treatment for early-onset scoliosis. J Bone Joint Surg Am 2010;92:2533–43.

    Article  PubMed  Google Scholar 

  30. Smith JT, Johnston C, Skaggs D, et al. A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 2015;35:798–803.

    Article  PubMed  Google Scholar 

  31. Bull C, Yates R, Sarkar D, et al. Scientific, ethical, and logistical considerations in introducing a new operation: a retrospective cohort study from paediatric cardiac surgery. BMJ 2000;320:171–3.

    Article  Google Scholar 

  32. Gang C, Haibo L, Fancai L, et al. Learning curve of thoracic pedicle screw placement using the free-hand technique in scoliosis: how many screws needed for an apprentice? Eur Spine J 2012;21: 1151–6.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gonzalvo A, Fitt G, Liew S, et al. The learning curve of pedicle screw placement: how many screws are enough? Spine (Phila Pa 1976) 2009;34:E761–5.

    Article  PubMed  Google Scholar 

  34. Samdani AF, Ranade A, Sciubba DM, et al. Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J 2010;19:91–5.

    PubMed  Google Scholar 

  35. Hammond JW, Queale WS, Kim TK, McFarland EG. Surgeon experience and clinical and economic outcomes for shoulder arthroplasty J Bone Joint Surg Am 2003;85:2318–24.

    Article  PubMed  Google Scholar 

  36. Paul JC, Lonner BS, Toombs CS. Greater operative volume is associated with lower complication rates in adolescent spinal deformity surgery. Spine (Phila Pa 1976) 2015;40:162–70.

    Article  Google Scholar 

  37. Ramsay CR, Wallace SA, Garthwaite PH, et al. Assessing the learning curve effect in health technologies: lessons from the nonclinical literature. Int J Technol Assess Health Care 2002;18:1–10.

    PubMed  Google Scholar 

  38. Karol LA, Johnston C, Mladenov K, et al. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am 2008;90:1272–81.

    Article  PubMed  Google Scholar 

  39. Perhrsson K, Larsson V, Oden A, Nachemson A. Long-term followup of patients with untreated scoliosis a study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976) 1992;17:1091–6.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of Utah, 201 Presidents Cir, Salt Lake City, UT, 84112, USA

    John A. Heflin MD, Graham T. Fedorak MD, FRCSC, Angela P. Presson PhD, Jessica V. Morgan BS & John T. Smith MD

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  1. John A. Heflin MD
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  2. Graham T. Fedorak MD, FRCSC
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  3. Angela P. Presson PhD
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  4. Jessica V. Morgan BS
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  5. John T. Smith MD
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Corresponding author

Correspondence to John T. Smith MD.

Additional information

Author disclosures: JAH (personal fees from Globus Medical, personal fees from Medtronic Sofamor Danek, outside the submitted work), GTF (none), APP (none), JVM (none), JTS (personal fees from Biomet, nonfinancial support from Children’s Spine Foundation, personal fees from DePuy, a Johnson & Johnson Company, personal fees from Ellipse Technologies; NuVasive, personal fees from Globus Medical, personal fees from Spineguard, outside the submitted work).

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Heflin, J.A., Fedorak, G.T., Presson, A.P. et al. Surgeon Experience Does Not Change Rate of Perioperative Surgical Complication in Rib-Based Distraction Surgery for Early-Onset Scoliosis. Spine Deform 6, 600–606 (2018). https://doi.org/10.1016/j.jspd.2018.01.012

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  • DOI: https://doi.org/10.1016/j.jspd.2018.01.012

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