ICU care questioned for scoliosis surgery in teens
By Lynda Williams, Senior medwireNews Reporter
19 April 2013
J Bone Joint Surg 2013; Advance online publication

medwireNews: Intensive care unit (ICU) admission may be unnecessary after spinal fusion for adolescent idiopathic scoliosis for patients without complications, research suggests.

The chart review found that the 58 patients cared for on the general hospital floor required significantly less analgesic and anxiety medication, fewer blood tests and physical therapy sessions, and a shorter hospital stay (6.1 vs 5.7 days) than the 66 patients whose postoperative care was managed in the ICU.

In particular, hospital floor patients required less intravenous morphine on average than ICU patients (74 vs 87 mg) and less diazepam (15 vs 23 mg), although oral opiate and intravenous ketorolac use was comparable.

The groups were comparable with regard to age at time of surgery, weight, intraoperative blood loss, preoperative and postoperative Cobb angles, maximum correction achieved, and the number of levels fused.

ICU patients spent an average of 2.4 days in the unit. None of the patients admitted to the general ward were later transferred to the ICU.

Admission to the ICU care significantly increased the cost of treatment (16%), at US$ 39,252 (€ 30,052) versus US$ 33,121 (€ 25,357) for patients admitted to the general floor.

"At our tertiary-care center, where approximately 100 spinal fusion surgical procedures for adolescent idiopathic scoliosis are performed each year, this total difference in hospital charges results in a savings of approximately $610,000 [€ 467,551] per year," comment Le-qun Shan (Children's Hospital Los Angeles, California, USA) and co-authors.

Writing in the Journal of Bone and Joint Surgery, the researchers say: "We believe that there are patients undergoing posterior spinal instrumentation and fusion surgery for adolescent idiopathic scoliosis for whom the intensive care unit should be considered for postoperative care, such as those with intraoperative neurologic complications who need postoperative management of blood pressure, allergic reaction, excessive blood loss and/or fluid shifts, and other circumstances."

Nevertheless, they conclude: "Patients with adolescent idiopathic scoliosis undergoing posterior spinal instrumentation and fusion surgery without complications can be managed perioperatively on the hospital floor without intensive care unit management, which can result in decreased costs and improved patient outcomes."

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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