title: Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization?: a multicenter analysis of 325 adolescent idiopathic scoliosis curves.
abstract: BACKGROUND
  The treatment of patients with large adolescent idiopathic scoliosis curves has been associated with increased surgical complexity. The purpose of this study was to determine whether surgical correction of larger adolescent idiopathic scoliosis curves increased the utilization of health-care resources and to identify potential predictors associated with increased perioperative health-care resource utilization.
  
  
  METHODS
  A nested cohort of patients with adolescent idiopathic scoliosis with Lenke type 1A and 1B curves were identified from a prospective longitudinal multicenter database. Four perioperative outcomes were selected as the primary health-care resource utilization outcomes of interest: operative time, number of vertebral levels instrumented, duration of hospitalization, and allogeneic blood transfusion. The effect of curve magnitude on these outcomes was assessed with use of univariate and multivariate regression.
  
  
  RESULTS
  Three hundred and twenty-five patients with a mean age of 15 ± 2 years were included. The mean main thoracic curve was 54.4° ± 7.8°. Larger curves were associated with longer operative time (p = 0.03), a greater number of vertebral levels instrumented (p = 0.0005), and the need for blood transfusion (with every 10° increase associated with 1.5 times higher odds of receiving a transfusion). In addition to curve magnitude, surgical center, bone graft method, and upper and lower instrumented levels were strong predictors of operative time (R2 = 0.76). The duration of hospitalization was influenced by the surgical center and intraoperative blood loss (R2 < 0.4), whereas the number of levels instrumented was influenced by the curve magnitude, curve correction percentage, upper instrumented vertebra, and surgical center (R2 = 0.64).
  
  
  CONCLUSIONS
  Correction of larger curves was associated with increased utilization of perioperative health-care resources, specifically longer operative time, a greater number of vertebral levels instrumented, and higher odds of receiving a blood transfusion.
authors.affiliation: Department of Orthopedics, British Columbia Children’s Hospital, A200-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. fmiyanji@cw.bc.ca
authors.forename: Firoz
authors.initials: F
authors.lastname: Miyanji
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Reilly
authors.forename: Bronwyn L
authors.initials: BL
authors.lastname: Slobogean
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae; D008297:Male; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care / Q000706:statistics & numerical data*; D012600:Scoliosis / Q000473:pathology* / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013904:Thoracic Vertebrae