Teens' spine surgery waits should be cut: study

Teens who wait more than three months for surgery to correct their curved spines risk complications such as worsening curvature, Canadian researchers have found.
Dr. Gary Deutchman analyzes an X-ray of a scoliosis patient in New York in 2008. (Peter Kramer/Associated Press/Scoliosis Systems)

Teens who wait more than three months for surgery to correct their curved spines risk complications such as worsening curvature, Canadian researchers have found.

Scoliosis affects just over two per cent of females aged 12 to 14, and is the most common procedure performed in pediatric orthopedics, doctors say.

Monday's issue of the Canadian Medical Association Journal includes two studies on wait times faced by children and adolescents, which the federal government identified as a priority area in 2007. 

In the case of scoliosis, patients who wait too long for surgery may need more surgery to achieve satisfactory correction of the spinal curvature, and may be at increased risk for complications such as blood loss and neurological deficits, said Dr. Henry Ahn of St. Michael's Hospital in Toronto and his co-authors.

"The highest risks of adverse events due to prolonged wait times occurred in patients who were skeletally immature and had larger curvatures of the spine," wrote Ahn and his co-authors.

Patients with these risks should be prioritized and monitored for progression or worsening of curvature, the researchers suggested.

Based on the evidence they reviewed, the authors concluded that a shorter wait target of three months for surgery for adolescents could potentially eliminate the need for further operations to reduce progression or worsening of curvature.

"This is a shorter access target than the six months determined by expert consensus."

Of the 88 patients in the study who waited longer than six months, 13 or nearly 15 per cent needed more surgery because of worsening of curvature, compared with two out of 128 patients, or 1.6 per cent among those who waited less than six months for surgery.

Patients who waited longer also had longer surgeries and longer hospital stays.

Pediatric hospital patients also have long waits

A second study in the same issue concluded 27 per cent of children at pediatric hospitals in Canada wait too long for surgery.

The review was based on 64,012 surgeries at Canada's pediatric academic health centres.

Surgeon Dr. James Wright of Toronto's Hospital for Sick Children and his co-authors drew similar conclusions about the areas with the highest percentage of delayed surgeries in a report released last year by the Wait Times Alliance: 

  • Dentistry, 45 per cent.
  • Ophthalmology, 3 per cent.
  • Plastic surgery, 35 per cent. 

Delays in surgery can affect children's physical and cognitive development.

For example, delaying surgery to correct strabismus or wandering eye risks a child's chances of having normal vision and can affect quality of life.

Likewise, cleft lip and/or palate surgery must be performed at specific times to ensure optimal speech and brain development.

Other areas of delayed pediatric surgeries were cancer, neurosurgery and cardiac surgery.

"We believe this national collaborative project shows the feasibility and potential benefits of setting nationals standards for surgical wait times. Such accountability can result in measurably improved access in the delivery of national publicly funded health care," Wright's team concluded.