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Journal of Current Pediatric Research | Volume: 23
March 14-15, 2019 | London, UK
International Conference on
Pediatrics & Neonatal Healthcare
A Retrospective Descriptive Cohort study of Preoperative, Intraoperative and Postoperative
Management of children in Scoliosis Surgery
Claudine Kumba
Necker Sick Children’s University Hospital, France
Background:
What is already known: Scoliosis surgery in
children is a common intervention in pediatric tertiary centers.
These patients depending on the type of scoliosis, idiopathic or
neuromuscular or congenital have also severe comorbidities
which necessitate management in specialized centers. Blood
and fluid loss can be important issues in this setting. Scoliosis
surgeryhasahighrateof postoperativecomplications.Dataexist
concerning the importance of goal directed fluid therapy and
hemodynamic monitoring to minimize postoperative morbidity
in moderate to high risk adult patients undergoing moderate
to high risk surgery. Evidence has shown that blood transfusion
protocols (based on viscoelastic methods, erythropoietin and
iron supplementation) can reduce blood product exposure
in this setting. It is known that transfusion is a predictive
factor of negative postoperative outcome in children. Rapid
enhanced protocols have shown to reduce length of hospital
stay and complications in adults. In children these protocols
are beginning to develop. What is not known: The impact of
intraoperative fluid and hemodynamic goal directed therapy
on postoperative outcome in pediatric surgery in general is not
known. Objective: The primary objective of this study was to
identify postoperative negative outcome predictors in pediatric
scoliosis surgery which could be improved by implementing
protocols based on existing evidence. Main outcome measures
of postoperative negative outcome were complications and
transfusion.
Methods:
Medical records of children admitted for scoliosis
surgery were retrospectively analyzed from 1 January 2015
to 8 December 2017 in Queen Fabiola Children’s University
Hospital, Brussels. Forty-one children with an average age of
13.15±2.79 years were included. Main outcomemeasures were
postoperative complications and transfusion. XLSTAT 2018.3
software was used for statistical analysis.
Results:
Length of postoperative hospital stay (LOSHOSP) was
predictive of postoperative complications and transfusion
with an odds ratio of 1.337 [1.048-1.705], p=0.019. Cobb’s
angle (p=0.002), length of surgery (p< 0.0001) and length
of postoperative α2 agonists infusion (p<0.0001) were
independent predictive factors of postoperative transfusion.
Conclusion:
Implementing improvement protocols aiming to
reduce length of hospital stay such as fluid, hemodynamic,
transfusion goal-directed therapies and enhanced recovery
pathways may upgrade postoperative outcome in pediatric
scoliosis surgery.
Speaker Biography
ClaudineKumbagraduatedasaMedicalDoctor in2001andcompletedherspecialisation
in Anesthesiology in 2006 at the Free University of Brussels (ULB, Université Libre de
Bruxelles). She has a Paediatric Anaesthesia specialisation graduation since 2010 from
the University of Aix- Marseille, Marseille, France. She has a Critical Care Medicine
specialisation graduation since 2014 from the University of Montpellier 1, Montpellier,
France. She is a paediatric anaesthesiologist in Necker Sick Children’s University
Hospital, in Paris, France. She has 12 publications and 17 citations. She is a member
of the European Society of Paediatric Anaesthesiology (ESPA), the French Society of
Anaesthesia and Critical Care (SFAR, Société Française d’Anesthésie-Réanimation) and
the French Association for Paediatric Anaesthesiolgists and Intensivists) (ADARPEF,
Association d’Anesthésistes et Réanimateurs Pédiatriques d’Expression Française) and
the Belgian Association for Paediatric Anaesthesiology (BAPA).
e:
claudine.kumba@gmail.comNotes:
Claudine Kumba
, Curr Pediatr Res, Volume 23
DOI: 10.4066/0971-9032-C1-011