Introduction Historically, assessment of operative risk in children prior to scoliosis surgery has been largely based on pre-operative lung function testing. Children having scoliosis surgery suffer from a wide range of conditions and many are unable to perform lung function testing. Furthermore, the risk of post-operative ventilation is decreasing suggesting better predictors may be needed. We currently evaluate all such patients, using assessment of airway competency, cough strength, and muscle bulk in estimating the risk of requiring post-operative ventilation. Our data suggest that lung function testing is no longer a good predictor of outcome in this group of patients.
Methods We retrospectively reviewed the records of 97 patients who have undergone scoliosis surgery between 2004 and 2010. Pulmonary function testing (PFT) was attempted wherever possible. Patients were clinically assessed prior to surgery, and an estimated risk of post-operative ventilation made. Comparison of each method (PFT and clinical assessment) against a primary outcome of requirement for post-operative ventilation, and secondary outcomes of PICU/HDU and hospital length of stay.
Results PFT was successful in 68/97 (70%) of our patients. One child had an FVC<40% predicted and three children had FVC 40–50% predicted. None of these children required ventilation post-operatively. Of the 14 patients who required post-operative ventilation, pulmonary function testing was only possible for four (FVC range 59%–74% predicted). The remaining 10 who needed ventilation were unable to perform PFT. Clinical assessment of risk was highly accurate in predicting the number of children requiring post-operative ventilation in all groups (Abstract P80 Table 1).
Conclusions The group of patients who are most likely to require post-operative ventilation are poor candidates for pulmonary function testing. To assess these children we need to take account of other factors which are important for their respiratory function post-operatively. Clinical assessment of risk can be highly accurate in predicting the need for ventilation following scoliosis surgery.
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