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Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia

INTRODUCTION: Patients with nonidiopathic scoliosis often have a high risk associated with general anesthesia because of cardiac or pulmonary dysfunction secondary to underlying diseases. Base excess has been reported as a predictor in the management of trauma and cancer, although not yet in scolios...

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Autores principales: Kanda, Yutaro, Kakutani, Kenichiro, Egi, Moritoki, Zhang, Zhongying, Yurube, Takashi, Takeoka, Yoshiki, Miyazaki, Kunihiko, Ohnishi, Hiroki, Matsuo, Tomoya, Ryu, Masao, Hoshino, Yuichi, Kuroda, Ryosuke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society for Spine Surgery and Related Research 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257964/
https://www.ncbi.nlm.nih.gov/pubmed/37309499
http://dx.doi.org/10.22603/ssrr.2022-0186
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author Kanda, Yutaro
Kakutani, Kenichiro
Egi, Moritoki
Zhang, Zhongying
Yurube, Takashi
Takeoka, Yoshiki
Miyazaki, Kunihiko
Ohnishi, Hiroki
Matsuo, Tomoya
Ryu, Masao
Hoshino, Yuichi
Kuroda, Ryosuke
author_facet Kanda, Yutaro
Kakutani, Kenichiro
Egi, Moritoki
Zhang, Zhongying
Yurube, Takashi
Takeoka, Yoshiki
Miyazaki, Kunihiko
Ohnishi, Hiroki
Matsuo, Tomoya
Ryu, Masao
Hoshino, Yuichi
Kuroda, Ryosuke
author_sort Kanda, Yutaro
collection PubMed
description INTRODUCTION: Patients with nonidiopathic scoliosis often have a high risk associated with general anesthesia because of cardiac or pulmonary dysfunction secondary to underlying diseases. Base excess has been reported as a predictor in the management of trauma and cancer, although not yet in scoliosis. This study was performed to clarify the surgical outcomes and the association of perioperative complications with base excess in patients with nonidiopathic scoliosis who have a high risk associated with general anesthesia. METHODS: Patients with nonidiopathic scoliosis who were referred to our institution from 2009 to 2020 because of their high risk associated with general anesthesia were retrospectively enrolled. High-risk factors for anesthesia were determined by a senior anesthesiologist and categorized into circulatory or pulmonary dysfunction. Perioperative complications were analyzed using the Clavien-Dindo classification; severe complications were defined as grade ≥III. We investigated high-risk factors for anesthesia, underlying diseases, preoperative and postoperative Cobb angle, surgery-related factors, base excess, and postoperative management. These variables were statistically compared between patients with and without complications. RESULTS: Thirty-six patients (mean age, 17.9 years old; range, 11-40 years old) were enrolled (two patients declined surgery). High-risk factors were circulatory dysfunction in 16 patients and pulmonary dysfunction in 20 patients. The mean Cobb angle improved from 85.1° (36°-128°) preoperatively to 43.6° (9°-83°) postoperatively. Three intraoperative complications and 23 postoperative complications occurred in 20 (55.6%) patients. Severe complications occurred in 10 (27.8%) patients. All patients underwent postoperative intensive care unit management after posterior all-screw construction. A large preoperative Cobb angle (p=0.021) and base excess outliers (>3 or <−3 mEq/L) (p=0.005) were significant risk factors for complications. CONCLUSIONS: Patients with nonidiopathic scoliosis who have a high risk associated with general anesthesia have a higher complication rate. Preoperative large deformity and base excess (>3 or <−3 mEq/L) could be predictors of complications.
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spelling pubmed-102579642023-06-12 Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia Kanda, Yutaro Kakutani, Kenichiro Egi, Moritoki Zhang, Zhongying Yurube, Takashi Takeoka, Yoshiki Miyazaki, Kunihiko Ohnishi, Hiroki Matsuo, Tomoya Ryu, Masao Hoshino, Yuichi Kuroda, Ryosuke Spine Surg Relat Res Original Article INTRODUCTION: Patients with nonidiopathic scoliosis often have a high risk associated with general anesthesia because of cardiac or pulmonary dysfunction secondary to underlying diseases. Base excess has been reported as a predictor in the management of trauma and cancer, although not yet in scoliosis. This study was performed to clarify the surgical outcomes and the association of perioperative complications with base excess in patients with nonidiopathic scoliosis who have a high risk associated with general anesthesia. METHODS: Patients with nonidiopathic scoliosis who were referred to our institution from 2009 to 2020 because of their high risk associated with general anesthesia were retrospectively enrolled. High-risk factors for anesthesia were determined by a senior anesthesiologist and categorized into circulatory or pulmonary dysfunction. Perioperative complications were analyzed using the Clavien-Dindo classification; severe complications were defined as grade ≥III. We investigated high-risk factors for anesthesia, underlying diseases, preoperative and postoperative Cobb angle, surgery-related factors, base excess, and postoperative management. These variables were statistically compared between patients with and without complications. RESULTS: Thirty-six patients (mean age, 17.9 years old; range, 11-40 years old) were enrolled (two patients declined surgery). High-risk factors were circulatory dysfunction in 16 patients and pulmonary dysfunction in 20 patients. The mean Cobb angle improved from 85.1° (36°-128°) preoperatively to 43.6° (9°-83°) postoperatively. Three intraoperative complications and 23 postoperative complications occurred in 20 (55.6%) patients. Severe complications occurred in 10 (27.8%) patients. All patients underwent postoperative intensive care unit management after posterior all-screw construction. A large preoperative Cobb angle (p=0.021) and base excess outliers (>3 or <−3 mEq/L) (p=0.005) were significant risk factors for complications. CONCLUSIONS: Patients with nonidiopathic scoliosis who have a high risk associated with general anesthesia have a higher complication rate. Preoperative large deformity and base excess (>3 or <−3 mEq/L) could be predictors of complications. The Japanese Society for Spine Surgery and Related Research 2022-12-12 /pmc/articles/PMC10257964/ /pubmed/37309499 http://dx.doi.org/10.22603/ssrr.2022-0186 Text en Copyright © 2023 The Japanese Society for Spine Surgery and Related Research https://creativecommons.org/licenses/by-nc-nd/4.0/Spine Surgery and Related Research is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Kanda, Yutaro
Kakutani, Kenichiro
Egi, Moritoki
Zhang, Zhongying
Yurube, Takashi
Takeoka, Yoshiki
Miyazaki, Kunihiko
Ohnishi, Hiroki
Matsuo, Tomoya
Ryu, Masao
Hoshino, Yuichi
Kuroda, Ryosuke
Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia
title Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia
title_full Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia
title_fullStr Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia
title_full_unstemmed Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia
title_short Preoperative Base Excess as a Predictor of Perioperative Complications in Patients with Nonidiopathic Scoliosis who Have High Risk Associated with General Anesthesia
title_sort preoperative base excess as a predictor of perioperative complications in patients with nonidiopathic scoliosis who have high risk associated with general anesthesia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10257964/
https://www.ncbi.nlm.nih.gov/pubmed/37309499
http://dx.doi.org/10.22603/ssrr.2022-0186
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