The goal of this randomized clinical trial is to compare the immediate use of steroids after surgery for accelerated discharge in adolescent idiopathic scoliosis and neuromuscular scoliosis after a posterior spinal fusion. The main question it aims to answer are: * What are the effects of using steroids immediately after surgery in decreasing opioid use and helping early mobilization(movement)? * Does post-operative steroid use affect the incidence of wound complications and are there any long-term impacts on scar formation? Participants will: * Fill out a Patient-Reported Outcomes Measurement Information System (PROMIS) survey specifically for pain interference and physical activity observing health related quality of life at enrollment, 3 months, 1 year, and 2 years * Have clinical photos of their incision at 3 months, 1 year, and 2 years * Their photos will be assessed using the stony book scar evaluation scale * For treatment of their scoliosis, patients will undergo a posterior spinal fusion (PSF) per standard of care, however whether the participant receives or does not receive steroids is what the investigators are trying to understand. * Researchers will compare no immediate postoperative steroid (NS) to the group with immediate postoperative steroid (WS) group to see if there are changes in opioid use, wound complications, scar formation, and facilitation in early mobilization.
Children remain a vulnerable population historically known to be undertreated and underrecognized for their pain, only perpetuating the complexity of managing pain control in this cohort. Children's Hospital of Los Angeles conducted a study observing patient and family's perioperative perception regarding their posterior spinal fusion and found that pain control is a primary concern, however, surgeons did not share the sentiment. Opioids were primarily the medication of choice with dentists and surgeons accounting for approximately two-thirds of opioid prescriptions. However, with the rise of the national opioid crisis and its adverse effects not limited to addiction, providers are gravitating towards alternative multidisciplinary use of medication to manage pain. Though steroids were formerly used for surgical patients, concerns regarding increased surgical site infection and wound healing complications were of major concern. However, to the investigators knowledge, these issues have only been documented with chronic steroid use. The impact of immediate use of steroids postoperatively for accelerated discharge has gained momentum in the literature with its demonstration in facilitating earlier mobility, decreased pain scores, and decreased narcotic usage. A retrospective study suggested that post-operative dexamethasone administration can have the positive effect of reducing opioid use in pediatric PSF patients without increasing wound complications. The proposed study aims to rigorously observe the effects of post operative steroid use in its facilitation in early mobilization in adolescent PSF patients, while also understanding the incidence of wound complications and long-term scar formation. Should the randomized controlled trial align with the literature, the implementation of post-operative steroids could potentially alter standard of care for adolescent PSF patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
100
Three (3) post operative intravenous dexamethasone injections at 8-hour intervals post-operatively. Dosing will be determined as 0.15 mg/kg per dose (WS)
Children's Hospital Los Angeles
Los Angeles, California, United States
Length of Stay
Day/hours to discharge from hospital following completion of surgery.
Time frame: From date of hospitalization for surgery until date of first discharge, assessed up to two weeks
Post Operative Opioid Use
Expressed as morphine milligram equivalent (MME, mg) units and weight-based MME (mg/kg)
Time frame: From date of hospitalization for surgery until date of first discharge, assessed up to two weeks
Post Operative Ambulation (for ambulatory patients)
Will obtain number of feet ambulated with physical therapy (PT) staff on each post operative day. Will record number of days postoperatively until PT clearance for discharge.
Time frame: From date of hospitalization for surgery until date of first discharge, assessed up to two weeks
Return of Bowel Function
Will record time to return of bowel sounds as noted by nursing or house staff. Will record time to first bowel movement.
Time frame: From date of hospitalization for surgery until date of first discharge, assessed up to two weeks
Rate of wound complications requiring intervention
3.1) Additional clinic visits for drainage or wound concerns will be recorded. 3.2) Use of antibiotic for superficial wound issues will be recorded. 3.3) Any additional operative intervention or hospitalization for concern/management of an infection.
Time frame: Less than 90 days from hospitalization
Scar Appearance
Clinical photos will be obtained and graded with Stony Brook Scar Evaluation Scale. The Stony Brook Scar evaluation scale ranges from a minimum value of 0 (worst) to a maximum value of 5 (best).
Time frame: Immediately from enrollment through study completion, at an average of 2 years
Patient-Reported Outcomes Measurement Information System (PROMIS)
The Patient-Reported Outcomes Measurement Information System is a validated quality of life and outcome questionnaire used for various studies. This will also be completed by the parent, if the patient is unable to do so. PROMIS domains that will be utilized include: 1. pain interference * A five-point Likert scale ranging from 1 ("never") to 5 ("almost always") is used. * A higher score is indicative of more problems with pain hindering activities than a lower score. 2. physical activity * A five-point Likert scale ranging from 1 ("never") to 5 ("almost always") is used. * A higher score is indicative of engagement with more physical activities than a lower score. 3. mobility * A five-point Likert scale ranging from 1 ("never") to 5 ("almost always") is used. * A higher score is indicative of engagement with more mobility than a lower score.
Time frame: Immediately from enrollment through study completion, at an average of 2 years
Post-Operative Complications
Any additional emergency room visits/readmission or revision surgery
Time frame: Within 2 years from date of surgery.
Body Mass Index
Weight, measured in kilograms, and height, measured in meters, will be combined to report body mass index in kg/m\^2
Time frame: Immediately from enrollment through study completion, at an average of 2 years
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