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Frequency and predictors of complication clustering within 30 days of spinal fusion surgery: a study of children with neuromuscular scoliosis
Journal article   Open access   Peer reviewed

Frequency and predictors of complication clustering within 30 days of spinal fusion surgery: a study of children with neuromuscular scoliosis

Sujay Rajkumar, Rajiv R Iyer, Lauren Stone, Michael P Kelly, Jillian Plonsker, Michael Brandel, David D Gonda, Marcus D Mazur, Daniel S Ikeda, Donald J Lucas, …
Spine deformity, v 12(3), pp 727-738
01 May 2024
DOI: https://doi.org/10.1007/s43390-023-00813-8
PMID: 38334901
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1007/s43390-023-00813-8View
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Abstract

Adolescent Child Female Humans Male Neuromuscular Diseases - complications Neuromuscular Diseases - epidemiology Operative Time Pneumonia - epidemiology Pneumonia - etiology Postoperative Complications - epidemiology Postoperative Complications - etiology Retrospective Studies Risk Factors Scoliosis - surgery Spinal Fusion - adverse effects Time Factors
There is limited information on the clustering or co-occurrence of complications after spinal fusion surgery for neuromuscular disease in children. We aimed to identify the frequency and predictive factors of co-occurring perioperative complications in these children. In this retrospective database cohort study, we identified children (ages 10-18 years) with neuromuscular scoliosis who underwent elective spinal fusion in 2012-2020 from the National Surgical Quality Improvement Program-Pediatric database. The rates of co-occurring complications within 30 days were calculated, and associated factors were identified by logistic regression analysis. Correlation between a number of complications and outcomes was assessed. Approximately 11% (709/6677 children with neuromuscular scoliosis undergoing spinal fusion had co-occurring complications: 7% experienced two complications and 4% experienced ≥ 3. The most common complication was bleeding/transfusion (80%), which most frequently co-occurred with pneumonia (24%) and reintubation (18%). Surgical time ≥ 400 min (odds ratio (OR) 1.49 [95% confidence interval (CI) 1.25-1.75]), fusion ≥ 13 levels (1.42 [1.13-1.79]), and pelvic fixation (OR 1.21 [1.01, 1.44]) were identified as procedural factors that independently predicted concurrent complications. Clinical risk factors for co-occurring complications included an American Society of Anesthesiologist physical status classification ≥ 3 (1.73 [1.27-2.37]), structural pulmonary/airway abnormalities (1.24 [1.01-1.52]), impaired cognitive status (1.80 [1.41-2.30]), seizure disorder (1.36 [1.12-1.67]), hematologic disorder (1.40 [1.03-1.91], preoperative nutritional support (1.34 [1.08-1.72]), and congenital malformations (1.20 [1.01-1.44]). Preoperative tracheostomy was protective against concurrent complications (0.62 [0.43-0.89]). Significant correlations were found between number of complications and length of stay, non-home discharge, readmissions, and death. Longer surgical time (≥ 400 min), fusion ≥ 13 levels and pelvic fixation are surgical risk factors independently associated with co-occurring complications, which were associated with poorer patient outcomes. Recognizing identified nonmodifiable risk factors might also be important for preoperative planning and risk stratification of children with neuromuscular scoliosis requiring spinal fusion. Level IV evidence.

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Orthopedics
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