title: Prevalence and risk factors in postoperative pancreatitis after spine fusion in patients with cerebral palsy.
abstract: BACKGROUND
  Postoperative pancreatitis is a recognized complication after spine fusion surgery in scoliosis management. There are established risk factors for the development of postoperative pancreatitis for patients with scoliosis in general, but no such factors have been established in patients with cerebral palsy (CP) who have scoliosis. The aim of this study was to assess the association between preoperative comorbidities and other parameters in the development of pancreatitis after spinal fusion surgery in a sample of children with CP.
  
  
  METHODS
  A retrospective cohort design was used to assess the association between postoperative pancreatitis and preoperative comorbidities and other covariates that might predispose to pancreatitis. The study participants included 355 patients, with a mean age of 13.8 years (range, 5.6-21 years) with CP, who received spine fusion with rod instrumentation. We used the chi statistic, mean, and SD to describe study variables that were categorical and continuous, respectively. To test the null hypothesis of no association between our outcome variable (postoperative pancreatitis) and comorbidities and other covariates as predictors, we used a binomial regression model. To simultaneously adjust for confounding effects in the relationship between our outcome and the independent or predictor variables, we used a multivariable binomial regression model.
  
  
  RESULTS
  Of the 355 patients who underwent spine fusion, 109 developed postoperative pancreatitis (prevalence, 30.1%). Patients who developed pancreatitis had prolonged number of fasting days (until oral or G-tube feeding initiated; 7.9 vs 5.2 days) and longer hospital stay (23.1 vs 15.6 days). In the univariable binomial regression model, patients with CP who had gastroesophageal reflux disease (GERD) and feeding difficulty were more likely to develop pancreatitis than those without this condition (risk ratio [RR], 1.57; 95% confidence interval [CI], 1.10-2.28, respectively). Likewise, in this model, gastrointestinal tube and reactive airway disease (RAD) were statistically significantly associated with postoperative pancreatitis. Patients with CP who had gastrointestinal tube were 61% more likely to develop postoperative pancreatitis, whereas those with RAD were 54% (RR, 1.61; 95% CI, 1.01-2.55 and RR, 1.54; 95% CI, 1.13-2.10, respectively). However, there was a clinically relevant but nonstatistically significant association between seizure and postoperative pancreatitis (RR, 1.72; 95% CI, 0.96-3.06). After adjustment for the confounding variables in the multivariable model, GERD with feeding difficulties persisted as a single most significant and potent predictor of postoperative pancreatitis (adjusted RR, 1.52; 95% CI, 1.01-2.29). Consequently, patients with CP who had GERD were 52% more likely to develop postoperative pancreatitis. Likewise, there was a statistically significant 49% increase in the risk of postoperative pancreatitis in patients with CP who had RAD (adjusted RR, 1.49; 95% CI, 1.10-2.04).
  
  
  CONCLUSIONS
  Pancreatitis is a major cause of morbidity after spinal fusion surgery in patients with CP. Patients with preoperative GERD with feeding difficulties and RAD had a higher risk of developing postoperative pancreatitis. Postoperative pancreatitis causes delays in feeding and increases the duration of hospitalization. Clinicians should be aware of the roles of GERD and RAD, as well as seizure and/or antiepileptics in the development of postoperative pancreatitis in patients with CP undergoing spinal fusion.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Orthopedics, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA.
authors.forename: Battugs
authors.initials: B
authors.lastname: Borkhuu
authors.forename: Durga
authors.initials: D
authors.lastname: Nagaraju
authors.forename: Freeman
authors.initials: F
authors.lastname: Miller
authors.forename: Mohamed Hassan
authors.initials: MH
authors.lastname: Moamed Ali
authors.forename: David
authors.initials: D
authors.lastname: Pressel
authors.forename: Judith
authors.initials: J
authors.lastname: Adelizzi-Delany
authors.forename: Margy
authors.initials: M
authors.lastname: Miccolis
authors.forename: Kirk
authors.initials: K
authors.lastname: Dabney
authors.forename: Larry
authors.initials: L
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007441:Intubation, Gastrointestinal; D008171:Lung Diseases / Q000150:complications; D008297:Male; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants