1
|
Chacon MA, Cook CA, Flynn-O'Brien K, Zagory JA, Choi PM, Wilson NA. Assessing the Impact of Neighborhood and Built Environment on Pediatric Perioperative Care: A Systematic Review of the Literature. J Pediatr Surg 2024; 59:1378-1387. [PMID: 38631997 PMCID: PMC11164636 DOI: 10.1016/j.jpedsurg.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Abstract
CONTEXT Neighborhood and built environment encompass one key area of the Social Determinants of Health (SDOH) and is frequently assessed using area-level indices. OBJECTIVE We sought to systematically review the pediatric surgery literature for use of commonly applied area-level indices and to compare their utility for prediction of outcomes. DATA SOURCES A literature search was conducted using PubMed, Ovid MEDLINE, Ovid MEDLINE Epub Ahead of Print, PsycInfo, and an artificial intelligence search tool (1/2013-2/2023). STUDY SELECTION Inclusion required pediatric surgical patients in the US, surgical intervention performed, and use of an area-level metric. DATA EXTRACTION Extraction domains included study, patient, and procedure characteristics. RESULTS Area Deprivation Index is the most consistent and commonly accepted index. It is also the most granular, as it uses Census Block Groups. Child Opportunity Index is less granular (Census Tract), but incorporates pediatric-specific predictors of risk. Results with Social Vulnerability Index, Neighborhood Deprivation Index, and Neighborhood Socioeconomic Status were less consistent. LIMITATIONS All studies were retrospective and quality varied from good to fair. CONCLUSIONS While each index has strengths and limitations, standardization on ideal metric(s) for the pediatric surgical population will help build the inferential power needed to move from understanding the role of SDOH to building meaningful interventions towards equity in care. TYPE OF STUDY Systematic Review. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Miranda A Chacon
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA
| | - Caitlin A Cook
- Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA
| | - Katherine Flynn-O'Brien
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 8915 W. Connell Ct., Milwaukee, WI 53226, USA
| | - Jessica A Zagory
- Division of Pediatric Surgery, Department of Surgery, Louisiana State University Health Sciences Center - New Orleans, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Pamela M Choi
- Department of Surgery, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134, USA
| | - Nicole A Wilson
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA; Department of Biomedical Engineering, University of Rochester, 601 Elmwood Ave, Box SURG, Rochester, NY 14642, USA.
| |
Collapse
|
2
|
Thornley P, Garner S, Rogers KJ, Yorgova P, Gabos PG, Shah SA. Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis. J Pediatr Orthop 2024; 44:e163-e167. [PMID: 37867376 DOI: 10.1097/bpo.0000000000002551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery. METHODS A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ 2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant. RESULTS The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients ( P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions ( P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions ( P < 0.001, P = 0.050) and decreased rates of obtaining second opinions ( P = 0.004, P = 0.001). CONCLUSION Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care. LEVEL OF EVIDENCE Level III; retrospective case-control study.
Collapse
Affiliation(s)
- Patrick Thornley
- Department of Orthopaedics, Nemours Children's Health, Wilmington, DE
| | | | | | | | | | | |
Collapse
|
3
|
Jamnik AA, Datcu AM, Lachmann E, Patibandla SD, Thornberg D, Jo CH, Morris WZ, Ramo B, Johnson M. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: a 30-year update. Spine Deform 2024; 12:99-107. [PMID: 37572225 DOI: 10.1007/s43390-023-00742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Although spinal fusion (SF) is considered "definitive" treatment in juvenile/adolescent idiopathic scoliosis (JIS/AIS), complications requiring reoperation continue to occur. The purpose of this study was to characterize the evolving rates of reoperation following SF in JIS/AIS. METHODS Single-center retrospective review of patients who underwent SF for JIS/AIS as their index surgical treatment between 2013 and 2019. Patient data were collected to identify complications requiring reoperation and factors associated with reoperation. Complication rates from 2013 to 2019 were compared to patients from 1988 to 2012 at the same institution. RESULTS This study analyzed 934 patients (81.7% female, mean age at surgery 14.5 ± 2.1). Thirty-eight patients (4.1%) required a total of 47 reoperations, a > 50% decrease in overall complication rate from the 2008-2012 population (4.1% vs 9.6%, respectively, p < 0.001). The decrease stemmed mainly from decreases in rates of infection (1.1% vs 4.1%, p < 0.001) and symptomatic implants (0.4% vs 2.1%, p = 0.004). There were, however, non-significant increases in implant failures (0.6% vs 0.2%, p = 0.4367) and pseudoarthrosis (1.0% vs 0.4%, p = 0.5202). Both of these complications were associated with patients with a higher mean weight (implant failure: 70.4 kg ± 21.1 vs 56.1 kg ± 14.9, p = 0.002; pseudoarthrosis: 85.8 kg ± 27.9 vs 55.9 ± 14.5, p = 0.001). CONCLUSIONS Reoperation following SF for JIS/AIS has decreased over the past 7 years when compared to 25 years of historical controls. The changing landscape of reoperation demands further research into the risk factors for those reoperations that have become more common.
Collapse
|
4
|
Orland K, Harvey K, Klinkerman LN, Corrales A, Jamnik A, Zale C, Jo CH, Rathjen K, McIntosh A, Petrasic J, Sucato DJ, Ramo B, Johnson M, Brooks JT. An Analysis of Scoliosis in Autism Spectrum Disorder. J Pediatr Orthop 2023; 43:e804-e808. [PMID: 37609890 DOI: 10.1097/bpo.0000000000002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Children with autism/Asperger are grouped into the diagnosis of autism spectrum disorder (ASD). It remains uncertain whether children with ASD and scoliosis have radiographic and clinical outcomes similar to idiopathic scoliosis (IS) patients. METHODS A single-center, retrospective review of a prospective scoliosis registry evaluated patients who had a posterior spinal fusion±Anterior Spinal Fusion and an underlying diagnosis of ASD between 1990 and 2021. A 2:1 match with AIS patients by age and sex was compared using demographic, radiographic, intraoperative, and SRS-22/30 variables. RESULTS Thirty patients with ASD (63% male, mean age at surgery 14.6±2.5 y) met inclusion criteria, with a follow-up of 2.46±1.00 years. Despite no differences in curve magnitude preoperatively, patients with ASD had a higher percent correction at 2-year follow-up (66% vs. 57%, P =0.01) and improved mean curve magnitude (20±10 degrees) at 2-year follow-up compared with IS patients (27±11 degrees, P <0.01). ASD patients had less lumbar lordosis preoperatively (40±12 vs. 53±14, P <0.01), but there were no significant differences in sagittal parameters at 2-year follow-up. There were no significant differences in the rate of complications at 2-year follow-up between ASD and AIS cohorts. CONCLUSIONS Although patients with ASD exhibited decreased lordosis compared with IS patients preoperatively, their radiographic outcomes at 2-year follow-up were the same. In addition, ASD patients maintained greater curve correction than IS patients at 2 years follow-up. LEVEL OF EVIDENCE Prognostic retrospective study.
Collapse
Affiliation(s)
| | | | | | | | | | - Connor Zale
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Tripler AMC, HI
| | | | - Karl Rathjen
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Amy McIntosh
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Jason Petrasic
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Daniel J Sucato
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Brandon Ramo
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Megan Johnson
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| | - Jaysson T Brooks
- Scottish Rite for Children
- Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX
| |
Collapse
|
5
|
Paul ME, Wallace JG, Coakley BA. An Assessment of the Relationship Between BMI and Children Undergoing Surgical Procedures: A Retrospective Study. Child Obes 2023; 19:249-257. [PMID: 35776521 PMCID: PMC10398724 DOI: 10.1089/chi.2022.0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: While multiple studies have documented that obesity increases the risk of operative complications among adults, little data exist on how obesity impacts surgical outcomes among children. We aimed to determine if children with obesity have different postoperative outcomes than their peers. Methods: A retrospective chart review was conducted of 875 patients aged between 2 and 18 years who underwent surgery during 2018. Patients were stratified, based on BMI percentile for age, as having less than healthy weight (<5th percentile), healthy weight (5th-84th percentile), excess weight (85th-94th percentile), or obesity (≥95th percentile). Demographic information and data on medical comorbidities and postoperative complications were collected. All analyses were conducted using chi-square or Kruskal-Wallis testing. Results: Eighty-two patients were excluded due to lack of BMI data and 56 were excluded as they had below healthy weight. Of the remaining 737 patients, 475 (64.4%) had healthy weight, 124 (16.8%) had excess weight, and 138 (18.70%) had obesity. Children with obesity had more tonsillectomy/adenoidectomy (p < 0.01) and vascular access (p = 0.04) procedures compared with peers. Additionally, patients with obesity were more likely to have a pre-existing history of liver disease (p < 0.01) and more frequently developed postoperative wound dehiscence (p < 0.01). No other complications occurred more frequently among children with obesity. Conclusions: Children with obesity required more tonsillectomy/adenoidectomy and vascular access procedures. Wound dehiscence was the only complication that was associated with obesity. This suggests that children with obesity are not inherently more prone to experience surgical complications and therefore elective procedures should likely not be deferred until preoperative weight loss is achieved.
Collapse
Affiliation(s)
- Megan E. Paul
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Brian A. Coakley
- Departments of Pediatrics and Surgery, Mount Sinai Health System, New York, NY, USA
| |
Collapse
|
6
|
Laubach L, Sharma V, Alsumait A, Chiang B, Kuester V. Socioeconomic Factors Correlation With Idiopathic Scoliosis Curve Type and Cobb Angle Severity. Cureus 2023; 15:e34993. [PMID: 36938294 PMCID: PMC10019979 DOI: 10.7759/cureus.34993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Race and socioeconomic status correlate with disease outcomes and treatment in patients with idiopathic scoliosis (IS) to varying degrees, although there is no clear association with Cobb angle and curve type. The purpose of this study was to assess socioeconomic factors and their association with Cobb angles in patients with IS. METHODS A retrospective chart review was completed with the radiographic analysis of 89 patients diagnosed with IS and spinal curves >10° between the ages of six and 18. Associations between the Cobb angles and socioeconomic categorical variables were analyzed using a nonparametric Kruskal-Wallis test and continuous variables using a Spearman Rank correlation. Results: There were no significant associations between proximal thoracic, main thoracic, or thoracolumbar/lumbar Cobb angles and sex, insurance type, race, access to healthy food, financial difficulty, or income. BMI and proximal thoracic Cobb angle (ρ = 0.2375, p=0.0268) had a significant positive correlation, and BMI and income (ρ = -0.2468, p=0.0228) shared a significant negative correlation. CONCLUSIONS The severity of IS proximal thoracic Cobb angles was positively associated with BMI and income. Other socioeconomic factors such as age, race, sex, access to food, insurance, and financial difficulties related to scoliosis treatment were not correlated with Cobb angle severity. The data presented suggest that patients with IS have varying degrees of curve type and severity that overall do not correlate with various socioeconomic factors. Validating which factors are predictive of curve severity could lead to early intervention preventing further morbidity of IS.
Collapse
Affiliation(s)
- Logan Laubach
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Viraj Sharma
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Abdulaziz Alsumait
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Benjamin Chiang
- General Surgery, Riverside University Health System Medical Center, Riverside, USA
| | - Victoria Kuester
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| |
Collapse
|
7
|
Chan CT. Association between body mass index and posterior spine fusion among patients with adolescent idiopathic scoliosis. PLoS One 2023; 18:e0286001. [PMID: 37200336 DOI: 10.1371/journal.pone.0286001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Previous studies have found mixed associations between body mass index (BMI) and adolescent idiopathic scoliosis (AIS) incidence and progression. The aim of this study was to examine the association between BMI and the incidence of posterior spine fusion (PSF) among pediatric patients with AIS. METHODS This was a retrospective cohort study of patients diagnosed with AIS at a single large tertiary care center between January 1, 2014 and December 31, 2020. BMI-for-age percentiles were used to categorize BMI into four categories: underweight (<5th percentile), healthy weight (≥5th to <85th percentile), overweight (≥85th to <95th percentile), and obese (≥95th percentile). Chi-square and t-tests were used to compare distributions of baseline characteristics by incident PSF outcome status. Multivariable logistic regression assessed the association between BMI category at baseline and incident PSF adjusting for sex, age at diagnosis, race/ethnicity, health insurance type, vitamin D supplementation, and low vitamin D levels. RESULTS A total of 2,258 patients met the inclusion criteria with 2,113 patients (93.6%) who did not undergo PSF during the study period and 145 patients (6.4%) who did undergo PSF. At baseline, 7.3% of patients were categorized as underweight, 73.2% were healthy weight, 10.2% were overweight, and 9.3% were obese. Compared to those in the healthy weight group, there was no significant association between PSF and being underweight (adjusted odds ratio [AOR] 1.64, 95% CI 0.90-2.99, p = 0.107), being overweight (AOR 1.25, 95% CI 0.71-2.20, p = 0.436), or being obese (AOR 1.19, 95% CI 0.63-2.27, p = 0.594). CONCLUSIONS This study did not find a statistically significant association between underweight, overweight, or obese BMI category and incident PSF among patients with AIS. These findings add to the current mixed evidence on the relationship between BMI and surgical risk and may support the recommendation of conservative treatment to patients regardless of BMI.
Collapse
Affiliation(s)
- Carrie T Chan
- Stanford Medicine Children's Health, Palo Alto, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
8
|
Tisano B, Anigian K, Kantorek N, Kenfack YJ, Johnson M, Brooks JT. The Insidious Effects of Childhood Obesity on Orthopedic Injuries and Deformities. Orthop Clin North Am 2022; 53:461-472. [PMID: 36208888 DOI: 10.1016/j.ocl.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The current childhood obesity epidemic, affecting approximately 20% of American children and adolescents, is accompanied by unique orthopedic manifestations. The growing musculoskeletal system is susceptible to the endocrine effects of obesity, resulting in decreased bone mass and quality. As a result, obese children are at increased risk of musculoskeletal injury, fracture, and lower extremity deformities. The efficacy of nonoperative treatment such as casting or bracing may be limited by body habitus and surgical treatment is accompanied by increased risk of perioperative complications.
Collapse
Affiliation(s)
- Breann Tisano
- Department of Orthopaedic Surgery, UT-Southwestern, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Kendall Anigian
- Department of Orthopaedic Surgery, UT-Southwestern, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Nyssa Kantorek
- UT-Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Yves J Kenfack
- UT-Southwestern School of Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Megan Johnson
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, USA
| | - Jaysson T Brooks
- Department of Orthopaedic Surgery, Scottish Rite for Children/UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, USA.
| |
Collapse
|