title: Risk factors for major complications after surgery for neuromuscular scoliosis.
abstract: METHODS
  Retrospective, case series.
  
  
  OBJECTIVE
  To determine the prevalence of major complications and to identify factors that increase the risk of complications in patients undergoing surgery for neuromuscular scoliosis.
  
  
  BACKGROUND
  Complications after surgery for neuromuscular scoliosis are more prevalent than in idiopathic scoliosis. However, the associated risk factors have not been statistically significant.
  
  
  METHODS
  Our computerized Pediatric Orthopedic Spine Database identified 131 consecutive patients with neuromuscular scoliosis, excluding those with myelodysplasia, who underwent surgery and had a minimum of 2 years of follow-up. Preoperative, intraoperative, and postoperative factors were analyzed for any association with major complications and length of stay using stepwise logistic and multiple regression analyses. Odds ratios were calculated for significant dichotomous variables, and receiver operator characteristic curves were created for significant continuous variables.
  
  
  RESULTS
  There were 81 male and 50 female patients with a mean age at surgery of 13.4 years (range, 6-21 years). The majority of patients (n = 75) had cerebral palsy. Eighty-eight patients (67%) underwent posterior spinal fusion and segmental spinal instrumentation (only), whereas 43 patients (33%) underwent an anterior spinal fusion followed by a posterior spinal fusion with segmental spinal instrumentation. Seventy-seven patients (59%) were fused to the pelvis using the Galveston technique. The mean follow-up was 3.9 years (range, 2-16.9 years). There were 46 major complications in 37 patients (28% prevalence), including 2 deaths.Nonambulatory status (P < 0.05) and preoperative curve magnitude (P < 0.01) were associated with an increased prevalence of major complications. Nonambulatory patients (n = 94) were almost 4 times more likely to have a major complication (odds ratio of 3.8, P < 0.05) in comparison with ambulatory patients. A preoperative major curve magnitude of ≥ 60° (P < 0.01) was the most accurate indicator for an increased risk for a major complication.
  
  
  CONCLUSIONS
  Nonambulatory status and a preoperative curve magnitude (≥ 60°) are directly associated with an increased risk for major complications and indirectly associated with increased length of stay. As such, we recommend operative intervention in neuromuscular scoliosis before curve progression to ≥ 60°. Level of Evidence. Level III.
authors.affiliation: Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Master
authors.forename: Jochen P
authors.initials: JP
authors.lastname: Son-Hing
authors.forename: Connie
authors.initials: C
authors.lastname: Poe-Kochert
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult