Perioperative outcomes in adolescent versus young adult patients with idiopathic scoliosis: how different are they?

Abstract

Objective: The aim of this study was to compare intra- and perioperative outcomes, complications, and magnitude of curve correction among patients with adolescent idiopathic scoliosis (AIS; 10-18 years old) and young adult idiopathic scoliosis (YAdIS; 19-40 years old).

Methods: A retrospective review of AIS and YAdIS patients who underwent primary corrective surgery at a single center was conducted. Demographic, radiographic, and operative data were collected at the pre- and perioperative periods. A 1:1 propensity score-matched analysis was implemented to limit selection bias by controlling for gender, curve type, total instrumented levels, and main coronal Cobb angle.

Results: Two hundred thirty-six patients (144 with AIS, 92 with YAdIS) were identified. Following propensity score matching, 85 matched pairs were identified. Radiographically, AIS had greater flexible main thoracic (mean -23.7% ± 14.1% vs -18.4% ± 11.0%, p = 0.0155) and thoracolumbar/lumbar curves (mean -32.0% ± 16.6% vs -28.5% ± 20.6%, p = 0.0229) preoperatively. The AIS group had a shorter operating room (OR) duration (mean 4.8 ± 1.3 vs 5.3 ± 1.5 hours, p = 0.0088), estimated blood loss (EBL; mean 654.7 ± 330.7 vs 806.7 ± 446.8 ml, p = 0.0092), and intraoperative transfusion rates (83.5% vs 96.5%, p = 0.0045). Postoperatively, the AIS patients had a lower rate of overall complications (9.4% vs 16.5%, p = 0.0412) and a lower transfusion rate (24.7% vs 40.0%, p = 0.0236). No differences in type of complication and hospital length of stay were observed (p > 0.05). AIS patients had smaller mean T10-12 thoracic kyphosis (TK; 6.3° ± 4.8° vs 9.0° ± 6.5°, p = 0.0242) and T1 pelvic angle (8.7° ± 8.2° vs 11.5° ± 8.7°, p = 0.048) postoperatively.

Conclusions: Patients with idiopathic scoliosis who undergo corrective surgery as adolescents had more flexible curves with shorter OR times, less EBL, and lower perioperative complication rates than young adults. Radiographic correction of the major coronal curve and of thoracic sagittal kyphosis was similar for both groups. Overall, AIS and YAdIS patients can expect generally successful operative outcomes and low complication rates.