Medtronic Grant Host Application Report
Host Name: David Skaggs
Host State: CA
Host Email: firstname.lastname@example.org
Site Name: Children's Hospital Los Angeles
Site Email: email@example.com
Host Desc: Children's Hospital Los Angeles has a clinical pediatric spine deformity practice. We conduct a large amount of research each year with at least 30+ publications. Research support includes a research coordinator, research assistant, 2 research fellows and statistician support. As for the clinical team, there are residents, fellows, physician assistants, and nurses, among others. There are 10 pediatric orthopaedists, 4 of which subspecialize in spine. They spend 50% of the time in the OR and 50% in clinic. In addition to research, the Medtronic fellow would be welcome to observe in both settings as their time and interest allow.
Research Opportunities: We have approximately 40 ongoing spine research projects at this time.
Comparison of Percentile Weight Gain of Growth-Friendly Constructs
Previous studies have evaluated the nutritional status of children with Early Onset Scoliosis to determine if treatment with growing rod instrumentation improves weight percentile. They found following growing rod treatment, there was significant improvement in nutritional status in approximately 50% of patients, similar to that reported with VEPTR. We would like to evaluate weight gain in EOS patients with other growth friendly implants as this has not been done before.
Does proximal implant density matter for anchor failure in distraction based implants?
Unpublished analysis from a previous comparison of growing spine implants suggested that increased number of proximal anchors decreased rate of implant failure (Sankar, Spine 2010). We want to also be able to answer these secondary questions: Does this vary between spine and rib anchors? Does it vary between VEPTR or traditional growing rod implants? Does down going hook on top of rib anchor have any effect? We believe the increased number of proximal anchors is associated with a decreased rate of implant failure. We plan to look at patients with dual and single rod constructs, rib vs. spine, pedicle screw vs. spine hook vs rib hook. We will collect fixation type and levels fused, rate of hardware failure, rate of infection, incidence of soft tissue problems, rate of revision for hardware implant prominence (at time of next lengthening or at separate surgery), T1-S1, and Cobb angle.
Transition to Accelerated Discharge Protocol in Patients with Adolescent Idiopathic Scoliosis
Length of stay following spinal fusion varies but averages 5.2 to 6.5 days (Daffner Spine 2010). Egleston Hospital (CHOA) has worked to develop a protocol which allows early discharge by the third postoperative day, cutting the average hospital stay nearly in half following spinal fusion. In this study we will critically evaluate the safety of this early discharge policy at CHLA and also assess the financial impact on our hospital before and after the accelerated discharge protocol was implemented at our site.
We want to compare complication rates, clinical outcomes and economics of this accelerated protocol that was implemented in June 2013 to the traditional discharge protocol. A retrospective review of patients treated at CHLA with posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) will be performed. Patients with AIS (10-18 yo) treated with PSF. We will exclude patients with anterior or staged procedures or any neurologic complications. Patient charts will be reviewed for demographic data and to determine length of surgery, number of fusion levels, estimated blood loss (EBL), ASA score, length of hospital stay, and any subsequent complications. Hospital charges will be reviewed to evaluate potential savings.