Surgeon Experience Does Not Change Rate of Perioperative Surgical Complication in Rib-Based Distraction Surgery for Early-Onset Scoliosis

Abstract

Objective: To report on the surgical learning curve in treating early-onset scoliosis with rib-based distraction.

Summary of background data: The idea of a surgical learning curve proposes improved outcomes with experience. Early-onset scoliosis (EOS) is a challenging condition to treat and complication rates are high.

Methods: All patients from a single experienced spine surgeon's practice who had undergone placement of rib-based distraction constructs between 2002 and 2013 were identified. A retrospective chart review was performed to determine patient characteristics at implantation and follow-up surgeries and complications. The primary outcome was complication rate per surgical encounter. Experience was analyzed both by number of surgical procedures and year in study period.

Results: The surgeon began using rib-based distraction in 2002, and between 2002 and 2013, a total of 101 patients underwent 1,009 implantation or expansion surgeries involving rib-based distraction at a median age of 6 years at implantation (10 months-9.4 years). The median preoperative Cobb angle was 67° (8°-125°; IQR: 57°-76°) and follow-up was a median of 4.4 years (IQR 3.7-5.6 years). Overall, 65.3% of patients experienced complications, including 40 Grade I, 20 Grade II, 126 Grade IIA, and 3 Grade III. Univariate analysis identified a trend toward cumulative number of surgeries relating to a decreased complication rate, with every 50 surgeries decreasing the complication rate by 3% (p = .071). However, multivariate analysis found cumulative number of surgeries and complication rate to not be significantly related (p = .12). Surgeon experience as measured by study time (as both a continuous and categorical predictor) did not achieve statistical significance in either the univariate or multivariate models.

Conclusion: This is the largest single-surgeon series of EOS patients treated with rib-based distraction. Surgeon experience defined either as number of procedures or years of experience within the study period did not impact the rate of complications.

Keywords: Complication; Early-onset scoliosis; Rib-based distraction.