Benefits of Best Practice Guidelines in Spine Fusion: Comparable Correction in Ais With Higher Density and Fewer Complications

dc.contributor.author Fernandes,P.
dc.contributor.author Flores,I.
dc.contributor.author Soares do Brito,J.
dc.date.accessioned 2024-07-05T15:50:14Z
dc.date.available 2024-07-05T15:50:14Z
dc.date.issued 2023
dc.description.abstract Background: There is significant variability in surgeons’ instrumentation patterns for adolescent idiopathic scoliosis surgery. Implant density and costs are difficult to correlate with deformity correction, safety, and quality of life measures. Materials and Methods: Two groups of postoperative adolescents were compared based on exposure to a best practice guidelines program (BPGP) introduced to decrease complications. Hybrid and stainless steel constructs were dropped, and posterior-based osteotomies, screws, and implant density were increased to 66.8 ± 12.03 vs. 57.5 ± 16.7% (p < 0.001). The evaluated outcomes were: initial and final correction, rate of correction loss, complications, OR returns, and SRS-22 scores (minimum two-year follow-up). Results: 34 patients were operated on before BPGP and 48 after. The samples were comparable, with the exceptions of a higher density and longer operative times after BPGP. Initial and final corrections before BPGP were 67.9° ± 22.9 and 64.6° ± 23.7; after BPGP, the corrections were 70.6° ± 17.4 and 66.5° ± 14.9 (sd). A regression analysis did not show a relation between the number of implants and postoperative correction (beta = −0.116, p = 0.307), final correction (beta = −0.065, p = 0.578), or loss of correction (beta= −0.137, p = 0.246). Considering screw constructs only (n = 63), a regression model controlled for flexibility continued to show a slight negative effect of density on initial correction (b = −0.274; p = 0.019). Only with major curve concavity was density relevant in initial correction (b = 0.293; p = 0.038), with significance at 95% not being achieved for final correction despite a similar beta (b = 0.263; p = 0.069). Complications and OR returns dropped from 25.6% to 4.2%. Despite this, no difference was found in SRS-22 (4.30 ± 0.432 vs. 4.42 ± 0.39; sd) or subdomain scores pre- and post-program. Findings: Although it appears counterintuitive that higher density, osteotomies, and operative time may lead to fewer complications, the study shows the value of best practice guidelines in spinal fusions. It also shows that a 66% implant density leads to better safety and efficacy, avoiding higher costs. © 2023 by the authors. en_US
dc.identifier.doi 10.3390/healthcare11111566
dc.identifier.issn 2227-9032
dc.identifier.scopus 2-s2.0-85161659512
dc.identifier.uri https://doi.org/10.3390/healthcare11111566
dc.identifier.uri https://hdl.handle.net/20.500.14411/4122
dc.language.iso en en_US
dc.publisher MDPI en_US
dc.relation.ispartof Healthcare (Switzerland) en_US
dc.rights info:eu-repo/semantics/openAccess en_US
dc.subject adolescent idiopathic scoliosis en_US
dc.subject complications en_US
dc.subject implant density en_US
dc.subject outcomes en_US
dc.title Benefits of Best Practice Guidelines in Spine Fusion: Comparable Correction in Ais With Higher Density and Fewer Complications en_US
dc.type Article en_US
dspace.entity.type Publication
gdc.author.scopusid 7102795237
gdc.author.scopusid 57213720735
gdc.author.scopusid 55846539900
gdc.coar.access open access
gdc.coar.type text::journal::journal article
gdc.description.department Atılım University en_US
gdc.description.departmenttemp Fernandes P., Department of Ophthalmology, Atilim University School of Medicine, Ankara, 06830, Turkey, Clínica Universitária de Ortopedia, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-035, Portugal; Flores I., ISCTE Instituto Universitário de Lisboa, Lisboa, 1649-026, Portugal; Soares do Brito J., Department of Ophthalmology, Atilim University School of Medicine, Ankara, 06830, Turkey, Clínica Universitária de Ortopedia, Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, Lisboa, 1649-035, Portugal en_US
gdc.description.issue 11 en_US
gdc.description.publicationcategory Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı en_US
gdc.description.volume 11 en_US
gdc.scopus.citedcount 1

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