title: Pediatric scoliosis surgery--is postoperative intensive care unit admission really necessary?
abstract: BACKGROUND
  It is common practice for patients to be admitted to the intensive care unit following scoliosis surgery, because of the prolonged anesthesia, the need for efficient pain control and the known immediate postoperative complications. However, this may be unnecessary in many patients.
  
  
  OBJECTIVE
  We aimed to establish possible associations between pre- and perioperative parameters and early postoperative complication rates, in particular the need for prolonged mechanical ventilation (>1 day), and the presence of major complications in children undergoing primary spinal fusion by thoracolumbar spine instrumentation.
  
  
  METHODS
  We conducted a retrospective review of children undergoing primary scoliosis surgery at a university-affiliated general hospital from 1998 to 2008.
  
  
  RESULTS
  Surgical approaches were as follows: anterior spinal fusion, posterior spinal fusion, and combined anterior and posterior fusion. Prior to mid-2005, anesthesia included morphine; thereafter, remifentanil was used. Major complications correlated significantly with neuromuscular scoliosis (NMS) (OR, 4.94; 95% CI, 1.02-24.05), comorbidity conditions (OR, 3.47; 95% CI, 1.16-10.42), and anterior or combined fusion (OR, 7.81; 95% CI, 2.12-28.57). Late extubation correlated significantly with NMS (OR, 31.25; 95% CI, 1.06-100.00) and morphine use during anesthesia (OR, 17.91; 95% CI, 1.44-222.9).
  
  
  CONCLUSIONS
  Relatively young, healthy idiopathic scoliosis children receiving intraoperative remifentanil sedation and undergoing posterior fusion can be successfully managed in regular wards in the immediate postoperative period. However, intensive care unit admission should be considered in NMS patients, patients with comorbidity conditions, those undergoing anterior or combined spinal fusion, and patients whose anesthesia involves long-acting opioids.
authors.affiliation: Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Israel. ibrahima@asaf.health.gov.il
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abu-Kishk
authors.forename: Eran
authors.initials: E
authors.lastname: Kozer
authors.forename: Roei
authors.initials: R
authors.lastname: Hod-Feins
authors.forename: Yoram
authors.initials: Y
authors.lastname: Anekstein
authors.forename: Yigal
authors.initials: Y
authors.lastname: Mirovsky
authors.forename: Baruch
authors.initials: B
authors.lastname: Klin
authors.forename: Gideon
authors.initials: G
authors.lastname: Eshel
mesh_terms: D000293:Adolescent; D000758:Anesthesia; D002648:Child; D003422:Critical Care; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007430:Intraoperative Care; D008297:Male; D015999:Multivariate Analysis; D019637:Orthopedic Procedures; D010343:Patient Admission; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012600:Scoliosis / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion