Evaluation And Research Of Early Post-operative Complications After Adolescent Idiopathic Scoliosis Correction Surgery

Section One Incidence and risk factors of early post-operative complications after adolescent idiopathic scoliosis surgeryObjectives There is an extensive spectrum of complications after surgery for correction of adolescent idiopathic scoliosis(AIS).However,there was a paucity of knowledge concerning anesthesia-associated factors.The aim of this study was to confirm predictive risk factors for peri-and early post-operative complications concerning anesthesia-associated factors.Methods A retrospective review of adolescents who underwent posterior spinal orthopedic surgery for AIS during the period December 2012 to January 2016 was performed.The type and incidence of peri-and early post-operative complications were recorded.To identify risk factors,candidate variables were selected for univariable analysis on clinical relevance.Multivariate logistic regression analyzed risk factors for(a)postoperative neurological decline;(b)non-neurological complications;(c)intraoperative massive blood loss.We also assessed(d)whether ASA classification can be used as a tool to assess risk stratification for AIS patients.Results There were 830 female and 156 male patients.The mean age at the time of surgery was 14.4 years(range 11 to 18 years).The overall prevalence of peri-and early post-operative complications was 19.5% and 2(0.2%)patients showed a postoperative neurological deficit.Non-neurological complications included postoperative nausea and vomiting(15.3%),wound healing problems(1.6%),pulmonary problems morbidities(1.4%),a implant-associated morbidity(0.1%),a fracture(0.1%),dural tears(0.2%),postoperative renal function injuries(0.2%)and allergic reactions to medication/blood products(0.3%).33(3.3%)patients had massive blood loss.Factors that did not correlate with an increased prevalence of peri-and early post-operative complications were age,ASA classification,presence of cardiac or respiratory disease,number of levels fused,surgeon experience,total intraoperative blood transfusion,whether dexmedetomindine was used.The factors significantly increased the rate of non-neurological complications include BMI,prolonged surgery time.Prolonged duration of operation,osteotomy procedure as factors significantly associated with a massive blood loss.ASA classification was not significantly associated with the occurrence of early postoperative complications.Conclusions The prevalence of peri-and early post-operative complications following posterior spinal orthopedic surgery for AIS in this study was 19.5%.The present study confirms several modifiable and non-modifiable risk factors for periand early post-operative morbidities,among which BMI,prolonged surgery time play a crucial role.ASA classification is not significantly associated with the occurrence of peri-and early postoperative complications.Section Two Analysis of early post-operative non-neurological complications after adolescent idiopathic scoliosis surgeryChapter ? Analysis of risk factors for postoperative nausea and vomiting requiring drug intervention following adolescent idiopathic scoliosis surgeryObjective To explore perioperative risk factors for postoperative nausea and vomiting(PONV)requiring drug intervention following adolescent idiopathic scoliosis(AIS)surgery.Methods The data of 986 patients(156 male and 830 female)undergoing AIS correction surgery from December 2012 to January 2016 in Nanjing Drum Tower Hospital concerning PONV was analyzed.The potential risk factors of PONV within 48h were screened out via univariate analysis and multivariate logistic regression.The intercept point is determined by the maximum value of the Youden index in the Receiver operating characteristic curve(ROC).Results 151 of 986 patients experienced PONV(15.3%).Multivariate logistic regression analysis suggested that marked ?Hb(OR=1.107,95%CI 1.060 ~1.157),administration of dexmedetomidine(OR=0.027,95%CI 0.006 ~ 0.123),administration of dexamethasone combined with ondansetron(OR=0.241,95% CI 0.066~0.886),administration of fentanyl as postoperative analgesia(OR=1.671,95% CI 1.381~2.284)were related to PONV in AIS correction surgery.Conclusion ?Hb > 28.5g/L,administration of fentanyl as postoperative analgesia were risk factors while administration of dexmedetomidine,administration of dexamethasone combined with ondansetron were protective factors for PONV.Chapter ? Risk factors associated with postoperative anemia after posterior spinal orthopedic surgery for adolescent idiopathic scoliosisObjective To investigate the risk factors of postoperative anemia after posterior spinal orthopedic surgery for AIS.Methods A total of 986 AIS patients(156 males and 830 females)underwent posterior orthopedic surgery,aged 11~18 years.Perioperative data of patients were recorded.Multivariate logistic regression analysis was performed to screen out independent risk factors for postoperative anemia.Results 407(41.2%)patients had postoperative anemia.Of those,215 patients(52.8%)had postoperative mild anemia and 137 patients(33.7%)had moderate anemia.Another 55 patients(13.5%)experienced severe anemia.Allogenic transfusion was performed in 221 patients(22.4%)after surgery.Multivariate logistic regression analysis showed that preoperative Hb < 126g/L(OR=1.960,95% CI 1.213~2.629), preoperative APTT > 38.95s(OR=1.037,95% CI 1.213 ~ 2.629),postoperative drainage volume > 485ml(OR=2.994,95% CI 1.435~4.221)were independent risk factors for postoperative anemia.The use of TXA(OR=0.605,95% CI 0.386-0.948)was a protective factor.Conclusion The incidence of anemia after posterior spinal orthopedic surgery for AIS is 41.2%.Preoperative Hb < 126 g / L,preoperative APTT >38.95 s,postoperative drainage > 485 ml were risk factors for postoperative anemia while the use of TXA was a protective factor.Chapter ? Current status and impact factors of postoperative pain in spinal correction surgery for adolescent idiopathic scoliosisObjective Postoperative pain is the most common problem after AIS surgery.However,there was a paucity of knowledge concerning its current status and related factors.The primary aim of the current study was to evaluate the current situation and the influencing factors of postoperative pain.Methods The data of 690 patients(205 male and 485 female)undergoing scoliosis surgery from December 2012 to January 2016 in Nanjing Drum Tower Hospital was collected.A numerical rating scale(NRS)was used to assess postoperative pain.The NRS scores at 6h,24 h,48h,and 72 h after surgery and the times and types of postoperative analgesic drugs were recorded.The related data included gender,age,ASA classification,BMI,cobb angle,the number of vertebral fusion,the volume of intraoperative blood loss,duration of operation,administration of patient-controlled intravenous analgesia(PCIA).The potential risk factors were analyzed.Results The mean age of 690 patients at the time of surgery was(14.7±4.1)years.The NRS score was(2.1±1.6)points 6 hours after surgery,(1.4±1.3)points 24 hours after surgery,(1.1±1.1)points 48 hours after surgery,(1.1±1.2)points 48 hours after surgery,respectively.The postoperative usage rate of non-steroidal antiinflammatory drugs,opioid analgesics and central analgesics was 97.8%,32.4%,1.2%,respectively.The duration of operation(OR=1.012,95% CI 1.003~1.021)was a risk factor for postoperative pain,the use of postoperative non-steroidal antiinflammatory drugs(OR=0.225,95% CI 0.054~0.929)and PCIA(OR=0.005,95% CI 0.003~0.010)were protective factors.Conclusion We found patients after posterior spinal orthopedic surgery had mild-tomoderate postoperative pain.The duration of operation was the risk factors for postoperative pain while the use of postoperative non-steroidal anti-inflammatory drugs and PCIA were the protective factors.Section Three Effect of tranexamic acid on perioperative hemorrhage and inflammatory response after posterior correction surgery for adolescent idiopathic scoliosisObjectives To investigate the effect of TXA on perioperative hemorrhage and inflammatory response,postoperative organ function and complications after posterior correction surgery for adolescent idiopathic scoliosis.Methods 60 AIS patients who underwent elective posterior scoliosis orthopedic surgery from January 2018 to June 2018 were randomly divided into two groups: group T(TXA 15mg/Kg was intravenous dripped before incision then administered with 10mg/Kg/h)and group C(administered 0.9% saline as control).Clinical observation indexes include:(1)the volume of crystalloid and colloid,blood loss,the volume of allogenic and autologous transfusion;(2)drainage volume 24 h,48h,72 h after surgery and 72 h total drainage volume;(3)coagulation parameters(APTT,PT,INR)liver and kidney function indicators(ALT,AST,BUN,Cr)at 24 h and 7 days after surgery;(4)Inflammatory indicator CRP;(5)postoperative complications.Results Compared with group C,the amount of intraoperative blood loss and blood transfusion(autologous/allogeneic),the drainage volume on the day after surgery,the drainage volume on the 1st day and the 3d total drainage volume were significantly reduced(P<0.05)in group T.There were no significant differences in postoperative APTT,PT,INR,ALT,AST,BUN and Cr between the two groups.Postoperative Hb and Hct were significantly higher in the group T(P<0.05).The CRP in group T was significantly lower than that of group C(P<0.05).There was no thromboembolic disease(deep vein thrombosis,pulmonary embolism),renal dysfunction,epilepsy or other related complications in the two groups.Conclusion TXA administered for AIS can significantly reduce the volume of intraoperative blood loss,blood transfusion,postoperative drainage and it reduce inflammatory reactions.It showed no significant effect on liver function,kidney function and coagulation function either does not increase the incidence of thromboembolic disease.