title: Quantifying Anesthesia Exposure in Growing Rod Treatment for Early Onset Scoliosis.
abstract: BACKGROUND
  Growing rod (GR) treatment for early-onset scoliosis requires repeated anesthesia exposure (AE). At a minimum, GR treatment requires AE for diagnostic imaging, index GR surgery, periodic lengthenings, and final fusion. Adjunct procedures and complication-related procedures also increase AE. To our knowledge, this is the first study to quantify AE in GR treatment and to establish preoperative expectations.
  
  
  METHODS
  A single-center retrospective review of 16 patients who completed GR treatment and underwent final fusion. Duration of all AE related to GR treatment for "standard" care procedures (ie, advanced imaging, index surgery, lengthenings, final fusion) and "associated" care procedures (ie, revisions, adjunctive surgical procedures, wound-related complications) were reviewed. Etiologies were classified per the classification of early-onset scoliosis. Mean total anesthesia time (TAT) was tallied and analyzed for standard care and associated care procedures.
  
  
  RESULTS
  There were 5 syndromic, 8 neuromuscular, and 3 idiopathic patients. The mean age at the first AE event related to GR treatment was 7.4 years (range, 3.8 to 11 y). Mean age at the index GR surgery and final fusion was 8.1 years (range, 3.9 to 14.4 y) and 12.8 years (range, 9.7 to 19 y), respectively. The percentage of TAT for each procedural category was 7% for advanced imaging, 14% for index GR, 14% for lengthenings, 21% for final fusion, 27% for revisions, 9% for adjunct surgery, and 9% for wound complications. Standard care procedures accounted for 55% of TAT, whereas associated care procedures accounted for 45%.
  
  
  CONCLUSIONS
  This study quantified expected duration of AE in GR treatment. Revisions and final fusion contributed most to TAT. Given the recent controversy of repeated AE in young children, efficiency measures should be implemented to reduce AE and avoid duplication without compromising the goals of surgical treatment. Associated care procedures accounted for 45% of the total AE.
  
  
  METHODS
  Level IV.
authors.affiliation: *San Diego Center for Spinal Disorders †Department of Orthopedic Surgery, Rady Children's Hospital ‡Department of Orthopaedic Surgery, University of California, San Diego, CA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Goldstein
authors.forename: Nima
authors.initials: N
authors.lastname: Kabirian
authors.forename: Jeff B
authors.initials: JB
authors.lastname: Pawelek
authors.forename: Navid R
authors.initials: NR
authors.lastname: Arandi
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.forename: Burt
authors.initials: B
authors.lastname: Yaszay
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.forename: Behrooz A
authors.initials: BA
authors.lastname: Akbarnia
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000145:classification / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome