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Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis.
Spine Deform 2019; 7(4):641-646SD

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.

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.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

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 -