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Li MMJ, Ocay DD, Larche CL, Vickers K, Saran N, Ouellet JA, Gélinas C, Ferland CE. Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery. Can J Pain 2023; 7:2156332. [PMID: 36874228 PMCID: PMC9980602 DOI: 10.1080/24740527.2022.2156332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults. Aims The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery. Methods Twenty-four patients (10-18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients' self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients' behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores. Results Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients' self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters. Conclusions These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.
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Affiliation(s)
- Mandy M J Li
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Don Daniel Ocay
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Cynthia L Larche
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Kelsey Vickers
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Neil Saran
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - Jean A Ouellet
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Catherine E Ferland
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Child Health and Human Development Research Axis, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
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Dinter K, Bretschneider H, Zwingenberger S, Disch A, Osmers A, Vicent O, Thielemann F, Seifert J, Bernstein P. Accelerate postoperative management after scoliosis surgery in healthy and impaired children: intravenous opioid therapy versus epidural therapy. Arch Orthop Trauma Surg 2023; 143:301-309. [PMID: 34302521 PMCID: PMC9886629 DOI: 10.1007/s00402-021-03972-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Postoperative pain is a major concern following scoliosis surgery. CEA (continuous epidural analgesia) is established in postoperative pain therapy as well as intravenous patient-controlled analgesia (IV-PCA). The purpose of this study was to compare the clinical outcomes of both methods. METHODS We retrospectively studied 175 children between 8 and 18 years who were subject to posterior scoliosis correction and fusion. Two main cohorts were formed: CEA with local anesthetic and opioids, and IV-PCA with opioids. Both groups further comprised two sub-cohorts: those who were mentally and/or physically healthy (H; n = 93 vs. n = 30) and those who were impaired (I; n = 26 vs. n = 26). The outcome parameters were the demand for pain medication, parameters of mobilization, and the presence of adverse reactions. RESULTS Healthy children who received CEA started mobilization 1 day earlier than children with IV-PCA (p = 0.002). First postsurgical defecation was seen earlier in all children who received CEA in both groups (H; Day 4 vs. Day 5, p = 0.011, I; Day 3 vs. Day 5, p = 0.044). Healthy children who received CEA were discharged from hospital 4 days earlier than their IV-PCA counterparts (p < 0.001). No statistically significant difference in postoperative nausea nor in vomiting was identified between groups. Transient neurological irritations were seen in 9.7% of the patients in the CEA group. CONCLUSIONS CEA provides appropriate pain management after scoliosis surgery, regardless of the patient's mental status. It allows earlier postoperative defecation for all patients , as well as shorter hospitalization and an earlier mobilization for healthy patients.
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Affiliation(s)
- Katharina Dinter
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Henriette Bretschneider
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Stefan Zwingenberger
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Alexander Disch
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Anne Osmers
- Department of Anesthesiology and Intensive Care Medicine, University Hospital “Carl Gustav Carus”, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Oliver Vicent
- Department of Anesthesiology and Intensive Care Medicine, University Hospital “Carl Gustav Carus”, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Falk Thielemann
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jens Seifert
- Department of Spine Surgery, AKG Klinik Hohwald GmbH, Hospital for Orthopaedics and Rheumatology, Hohwaldstraße 40, 01844 Neustadt in Sachsen, Germany
| | - Peter Bernstein
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Department of Spine Surgery, AKG Klinik Hohwald GmbH, Hospital for Orthopaedics and Rheumatology, Hohwaldstraße 40, 01844 Neustadt in Sachsen, Germany
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Chen CJ, Shah AA, Hsiue PP, Subhash AK, Lord EL, Park DY, Stavrakis AI. Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) After Primary Spinal Fusion: An Analysis of Outcomes and Risk Factors from 2005 to 2014. World Neurosurg 2021; 155:e612-e620. [PMID: 34481105 DOI: 10.1016/j.wneu.2021.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ogilvie syndrome (OS) is a rare but serious condition seen in the postoperative period. This was an epidemiologic study using data from the National Inpatient Sample from 2005 to 2014 to look at incidence, risk factors, and outcomes associated with OS after primary spine fusion. METHODS International Classification of Diseases, Ninth Revision codes were used to identify patients who underwent spine fusion surgery. Patients were separated into 2 cohorts based on the diagnosis of OS. Outcome measures and risk factors for cohorts were analyzed using multivariate logistic regression and compared. RESULTS Over the 10-year study period, 3,884,395 patients underwent primary spine fusion surgery. Among these, 0.04% developed OS during the index hospitalization. The greatest incidence seen in primary fusion involved the thoracic spine (0.15%). OS was more common after spine fusion for spine deformity (P < 0.001). Patients with OS were more likely to be men (P < 0.001), older (P < 0.0001), and have more comorbidities (P < 0.0001). Patients with OS were more likely to require postoperative blood transfusions (odds ratio [OR], 3.39; 95% confidence interval [CI], 2.51-4.59; P < 0.001) and sustain any complication (OR, 4.20; 95% CI, 3.17-5.57; P < 0.001). Patients with OS had a longer length of stay (15.7 vs. 3.9 days; P < 0.001) and increased average hospitalization cost ($63,037.03 vs. $26,792.19; P < 0.001). The development of OS was associated with fluid electrolyte disorder (OR, 4.06; 95% CI, 2.99-5.51; P < 0.001). CONCLUSIONS OS is a rare but serious complication of primary spine fusion surgery. Identifying the specific risk factors, symptoms, and potential complications related to OS is critical to aid in decreasing the significant morbidity associated with its development.
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Affiliation(s)
- Clark J Chen
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
| | - Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Ajith K Subhash
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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Belthur M, Bosch L, Wood W, Boan C, Miller F, Shrader MW. Perioperative management of patients with cerebral palsy undergoing scoliosis surgery: Survey of surgeon practices. J Pediatr Rehabil Med 2019; 12:205-212. [PMID: 31227661 DOI: 10.3233/prm-170504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Progressive scoliosis significantly impacts the quality of life in patients with cerebral palsy (CP). Spinal fusion is the mainstay of treatment of progressive spinal curves. The current study aims to identify approaches used by pediatric spine surgeons to optimize care of patients with CP undergoing scoliosis surgery. METHODS A 33-question survey was distributed electronically to 181 POSNA/SRS members with an established interest in pediatric spinal deformity surgery. Eighty one responses were obtained (45%). Using the Delphi consensus guidelines, agreement > 75% was considered as consensus. RESULTS There was a consensus on 15 out of 33 questions (46%). 97% of responders identified nutrition status as a comorbidity which could be optimized. However, the timing and method of obtaining nutritional assessment varied. 92% of the surgeons stated that they used shared decision making with the family but only 22% used a formal decision aid. 83% use antifibrinolytics routinely, 81% used a surgical site infection prevention protocol, 78% obtained preoperative pulmonary consult, and 88% took steps postoperatively to prevent pulmonary complications. CONCLUSION There is significant variability in the current practices of perioperative management of patients with CP undergoing scoliosis surgery. This data can be used in future studies to create a standardized integrated care pathway.
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Affiliation(s)
- Mohan Belthur
- Department of Orthopedics, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Liam Bosch
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - William Wood
- Department of Orthopedics, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Carla Boan
- Department of Orthopedics, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Freeman Miller
- Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - M Wade Shrader
- Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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