title: Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database.
abstract: OBJECTIVE
  Currently, few studies regarding morbidity and mortality associated with operative treatment of spinal disorders in children are available to guide the surgeon. This study provides more detailed morbidity and mortality data with an analysis of 23,918 pediatric cases reported in the multicenter, multisurgeon Scoliosis Research Society morbidity and mortality database.
  
  
  METHODS
  The Scoliosis Research Society morbidity and mortality database was queried for the years from 2004 to 2007. The inclusion criterion was age 18 years or younger. Cases were categorized by operation type and diagnosis. Details on the surgical approach, use of neurophysiological monitoring, and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Statistical analysis was performed with chi-square testing, with a p value < 0.05 considered significant.
  
  
  RESULTS
  A total of 23,918 patients were included. The mean age was 13 ± 3.6 years (± SD). Spinal pathology included the following: scoliosis (in 19,642 patients), kyphosis (in 1455), spondylolisthesis (in 748), trauma (in 478), and other (in 1595 patients). The overall complication rate was 8.5%. Major complications included wound infections (2.7%), new neurological deficits (1.4%), implant-related complications (1.6%), and hematomas (0.4%). The most common medical complications were respiratory related (0.9%). Morbidity rates differed based on pathology, with patients undergoing treatment for kyphosis and spondylolisthesis having higher overall rates of morbidity (14.7% and 9.6%, respectively). Patients undergoing revision procedures (2034) or corrective osteotomies (2787) were more likely to suffer a complication or new neurological deficit. The majority of these deficits improved at least partially. Thirty-one deaths were reported for an overall rate of 1.3 per 1000. Respiratory complications were the most common cause of mortality (13 cases). Twenty-six of the deaths occurred in children undergoing scoliosis correction.
  
  
  CONCLUSIONS
  Spinal surgery in children is associated with a range of complications depending on the type of operation. Mortality rates for all indications and operations were low. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications and new neurological deficits.
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Kai-Ming G
authors.initials: KM
authors.lastname: Fu
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Perra
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Richard E
authors.initials: RE
authors.lastname: McCarthy
authors.forename: D Raymond
authors.initials: DR
authors.lastname: Knapp
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000453:epidemiology / Q000601:surgery; D008297:Male; D015337:Multicenter Studies as Topic; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality*; D010027:Osteotomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012086:Reoperation; D012600:Scoliosis / Q000453:epidemiology / Q000601:surgery; D013122:Spinal Diseases / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D013124:Spinal Injuries / Q000453:epidemiology / Q000601:surgery; D013168:Spondylolisthesis / Q000453:epidemiology / Q000601:surgery; D014481:United States / Q000453:epidemiology