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Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis.

Abstract

STUDY DESIGN

Prospective cohort.

OBJECTIVE

To compare preoperative hemoglobin levels to postoperative hemoglobin levels in patients with early-onset scoliosis (EOS).

SUMMARY OF BACKGROUND DATA

Elevated hemoglobin (Hgb) may be a marker for preoperative hypoxia in patients with EOS and thoracic insufficiency syndrome (TIS). The changes in Hgb level after treatment may be a surrogate marker for improved oxygenation.

METHODS

Because normal levels of Hgb vary with patient age, Hgb z scores were calculated by dividing age-adjusted mean Hgb levels by the age-adjusted standard deviation. Elevated Hgb was defined by a hemoglobin z score >1. Patients with a baseline Hgb value measured before initial implantation with at least one follow-up measurement, at 6, 12, or 18 months, were included in longitudinal analysis. Change in Hgb z score as well as change in curve magnitude over time was assessed using piecewise linear mixed modeling for patients with elevated Hgb and those without.

RESULTS

Two hundred sixty-seven patients with EOS were treated surgically over the study period. Average age at initial implantation was 6.8 years. Forty-eight (18%; 95% confidence interval = 13.7%, 23.2%) subjects had an elevated Hgb (z score > 1) level before implantation procedure. Hgb levels decreased in subjects with elevated Hgb from implantation to 6 months (p < .001) with no change in Hgb from 6 to 12 months (p = .46) or from 12 to 18 months (p = .59), but an overall decrease from preoperative to 18 months (p < .001). There was no change in Hgb levels for subjects without elevated Hgb from implantation to 6 months (p = .94), from 6 to 12 months (p = .61), or from 12 to 18 months (p = .78).

CONCLUSIONS

In some patients with EOS and TIS, there appears to be significant positive impact on oxygenation from distraction instrumentation as evidenced by a meaningful proxy measurement: improvement in abnormal preoperative Hgb levels after surgery.

LEVEL OF EVIDENCE

III.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: Michael.Glotzbecker@childrens.harvard.edu.

    ,

    Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

    ,

    Department of Orthopaedic Surgery, Morgan Stanley Hospital, 3959 Broadway, New York, NY 10032, USA.

    ,

    Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

    ,

    Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

    ,

    Department of Orthopaedic Surgery, Campbell Clinic Orthopaedics, 1211 Union Ave Suite 500, Memphis, TN 38104, USA.

    ,

    Department of Orthopaedic Surgery, Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.

    ,

    Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.

    ,

    Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

    Source

    Spine deformity 7:4 2019 Jul pg 641-646

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31202383

    Citation

    Glotzbecker, Michael, et al. "Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis." Spine Deformity, vol. 7, no. 4, 2019, pp. 641-646.
    Glotzbecker M, Miller P, Vitale M, et al. Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis. Spine Deform. 2019;7(4):641-646.
    Glotzbecker, M., Miller, P., Vitale, M., DeWitt, L., Grzywna, A., Sawyer, J., ... Emans, J. (2019). Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis. Spine Deformity, 7(4), pp. 641-646. doi:10.1016/j.jspd.2018.11.002.
    Glotzbecker M, et al. Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis. Spine Deform. 2019;7(4):641-646. PubMed PMID: 31202383.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis. AU - Glotzbecker,Michael, AU - Miller,Patricia, AU - Vitale,Michael, AU - DeWitt,Leah, AU - Grzywna,Alexandra, AU - Sawyer,Jeffrey, AU - Pahys,Joshua, AU - Cahill,Patrick, AU - Emans,John, AU - ,, PY - 2018/01/11/received PY - 2018/10/30/revised PY - 2018/11/03/accepted PY - 2019/6/17/entrez PY - 2019/6/17/pubmed PY - 2019/6/17/medline KW - EOS KW - Early Onset Scoliosis KW - Hemoglobin KW - Pulmonary function SP - 641 EP - 646 JF - Spine deformity JO - Spine Deform VL - 7 IS - 4 N2 - STUDY DESIGN: Prospective cohort. OBJECTIVE: To compare preoperative hemoglobin levels to postoperative hemoglobin levels in patients with early-onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA: Elevated hemoglobin (Hgb) may be a marker for preoperative hypoxia in patients with EOS and thoracic insufficiency syndrome (TIS). The changes in Hgb level after treatment may be a surrogate marker for improved oxygenation. METHODS: Because normal levels of Hgb vary with patient age, Hgb z scores were calculated by dividing age-adjusted mean Hgb levels by the age-adjusted standard deviation. Elevated Hgb was defined by a hemoglobin z score >1. Patients with a baseline Hgb value measured before initial implantation with at least one follow-up measurement, at 6, 12, or 18 months, were included in longitudinal analysis. Change in Hgb z score as well as change in curve magnitude over time was assessed using piecewise linear mixed modeling for patients with elevated Hgb and those without. RESULTS: Two hundred sixty-seven patients with EOS were treated surgically over the study period. Average age at initial implantation was 6.8 years. Forty-eight (18%; 95% confidence interval = 13.7%, 23.2%) subjects had an elevated Hgb (z score > 1) level before implantation procedure. Hgb levels decreased in subjects with elevated Hgb from implantation to 6 months (p < .001) with no change in Hgb from 6 to 12 months (p = .46) or from 12 to 18 months (p = .59), but an overall decrease from preoperative to 18 months (p < .001). There was no change in Hgb levels for subjects without elevated Hgb from implantation to 6 months (p = .94), from 6 to 12 months (p = .61), or from 12 to 18 months (p = .78). CONCLUSIONS: In some patients with EOS and TIS, there appears to be significant positive impact on oxygenation from distraction instrumentation as evidenced by a meaningful proxy measurement: improvement in abnormal preoperative Hgb levels after surgery. LEVEL OF EVIDENCE: III. SN - 2212-1358 UR - https://www.unboundmedicine.com/medline/citation/31202383/Hemoglobin_Levels_Pre-_and_Posttreatment_as_a_Surrogate_for_Disease_Severity_in_Early-Onset_Scoliosis L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-134X(18)30280-6 DB - PRIME DP - Unbound Medicine ER -