Pleural Effusion Following Scoliosis/Kyphosis Surgery: Role of Postoperative Furosemide Therapy

Purpose: Surgical correction of scoliosis and kyphosis is achieved by anterior and / or posterior spinal fusion. This is often accompanied by multilevel costoplasties for correction of the posterior rib hump deformity. One of the potential complications of these surgeries is development of postoperative moderate to large pleural effusions. The effusion is usually drained with ultrasound guidance. We report our experience in utilizing pharmacologic methods (furosemide) in treating the effusion.

Methods: Use of postoperative furosemide therapy decreases the incidence of symptomatic pleural effusions that require to be tapped. We retrospectively reviewed all patients who had undergone scoliosis / kyphosis surgery with an anterior or posterior spinal fusion or both. The anterior fusion was performed either open or by VATS, with or without instrumentation. Autogenous rib or fibular strut allograft was used for fusion. All the patients who underwent an isolated posterior fusion also had a minimum 3 level costoplasty. The first part of the study involved 146 patients who did not receive postoperative furosemide. In the second part 19 patients were reviewed, and all of them received postoperative furosemide 20 mg PO daily. We studied the incidence of clinically symptomatic pleural effusions which required a subsequent pleural tap, in both groups. All pleural taps were performed with ultrasound guidance. Follow up chest radiographs were evaluated for a decrease or a resolution of the effusion.

Results: S: In the first part of the study, 26 out of the 146 (approx 1 out of every 5) patients had a clinically symptomatic effusion which required a pleural tap. In the second part of the study, out of the 19 patients who received postoperative oral furosemide therapy, only one patient required a pleural tap due to a persistent, large and symptomatic pleural effusion.

Conclusion: Drainage of a clinically symptomatic pleural effusion in patients following scoliosis or kyphosis surgery, with or without multilevel costoplasties, involves an invasive pleural tap, associated with discomfort to the patient and a minimal risk of an iatrogenic pneumothorax. Our experience suggests that oral furosemide therapy decreases the incidence of a clinically symptomatic pleural effusion requiring a pleural tap and also allows for successful treatment of pleural effusion in these patients.