RESUMO
STUDY DESIGN: Cross-sectional study. OBJECTIVES: Thus, this study aimed to assess the epidemiological profile of a patient sample that underwent spinal surgery regarding their nutritional and vitamin D status. METHODS: Serum albumin and vitamin D (25-hydroxyvitamin D) levels were measured in patients with different spinal surgical approaches and various pathologies at a single institution. 112 patients were retrospectively identified for inclusion and stratified by age into 4 age groups and by pathology. The nutritional status of the patients was classified in vitamin D inadequacy (< 30ng/mL), vitamin D deficiency (<20ng/mL), and hypoalbuminemia (<3.5g/dL). Data was analyzed comparing vitamin D, and albumin means considering gender, age group, and pathologies. RESULTS: Twenty-eight (25.2%) patients had hypoalbuminemia. There was no difference between gender (p = 0.988); there was a significant decrease in albumin concentration increasing the age (p < 0.001). The prevalence of hypoalbuminemia was significantly higher in patients with trauma, tumor and infection than in those patients with degenerative and deformity diseases (p = 0.003). The prevalence of vitamin D inadequacy was 33.7%, and that of deficiency was 62.2%, while severe deficiency (< 10 ng/mL) in 16.3%. The vitamin D concentration was significantly different among the pathologies (P = 0.047), the lower concentration occurring in patients with tumor. CONCLUSION: Older patients, as well as patients with tumor and infectious pathologies, seem to have a higher prevalence of hypoalbuminemia, inferring malnutrition. There was a low epidemic level of vitamin D concentration, almost all patients presenting some degree of hypovitaminosis D, independent of age, gender and nutritional status.
RESUMO
OBJECTIVES: To convey advice from families whose children recently underwent spinal fusion to families whose children are under consideration for initial spinal fusion for neuromuscular scoliosis and to providers who counsel families on this decision. STUDY DESIGN: We interviewed 18 families of children who underwent spinal fusion between August 2017 and January 2019 at a freestanding children's hospital. We conducted phone interviews a median of 65 (IQR 51-77) days after surgery. We audio recorded, transcribed, and coded (line-by-line) interviews using grounded theory by 2 independent reviewers, and discussed among investigators to induce themes associated with surgical decision making and preparation. RESULTS: Six themes emerged about decision making and preparation for spinal fusion: (1) simplify risks and benefits; it is easy to get lost in the details; (2) families prolonging the decision whether or not to pursue spinal fusion surgery may not benefit the child; (3) anticipate anxiety and fear when making a decision about spinal fusion; (4) realize that your child might experience a large amount of pain; (5) anticipate a long recovery and healing process after spinal fusion; and (6) be engaged and advocate for your child throughout the perioperative spinal fusion process. CONCLUSIONS: Parents of children who had recently undergone spinal fusion had strong perceptions about what information to convey to families considering surgery, which may improve communication between future parents and physicians. Further investigation is needed to assess how best to incorporate the wisdom and experiences of parent peers into shared decision making and preparation for spinal fusion in children with neuromuscular scoliosis.