title: Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors.
abstract: OBJECTIVE
  A prospective, longitudinal cohort was studied to determine the incidence, consequences, and risk factors of major perioperative complications in patients with cerebral palsy (CP) treated with spinal fusion. There is a wide variety of data available on the complications of spine surgery; however, little exists on the perioperative complications in patients with CP.
  
  
  METHODS
  A prospective multicenter dataset of consecutive patients with CP treated with spinal fusion was evaluated. All major perioperative complications were identified and stratified into categories: pulmonary, gastrointestinal, other medical, wound infection, neurological, instrumentation related, and unplanned staged surgery. Univariate and multivariate analyses were performed to identify various risk factors for major perioperative complications.
  
  
  RESULTS
  127 patients were identified with a mean age of 14.3 ± 2.6 years. Overall, 39.4% of the patients had a major perioperative complication. Occurrence of a complication [no complication (NC), yes complication (YC)] resulted in significantly increased intensive care unit (ICU) (NC = 3.2 days, YC = 7.8 days, p < 0.05) and hospital stays (NC = 7.7 days, YC = 15.6 days, p < 0.05). Variables associated with greater risk of a complication included: increased estimated blood loss (EBL) (p < 0.001), larger preoperative kyphosis (p = 0.05), staged procedures (p < 0.05), a lack of antifibrinolytic use (p < 0.05), and a trend toward lower body mass index (BMI) (p = 0.08). Multivariate regression analysis revealed an increased EBL as independently associated with a major perioperative complication (p < 0.05).
  
  
  CONCLUSIONS
  In this cohort of patients with CP who underwent spinal fusion, 39.4% experienced a major perioperative complication, with pulmonary being the most common. The occurrence of a major perioperative complication lengthened both ICU and hospital stay. Risk factors for major perioperative complications included greater preoperative kyphosis, staged procedures, a lack of antifibrinolytic use, and increased EBL, with the latter being an independent predictor of a major perioperative complication.
  
  
  METHODS
  2.
authors.affiliation: Shriners Hospitals for Children, Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA. amersamdani@gmail.com.
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.affiliation: Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Belin
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, PA, 19140, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Bennett
authors.affiliation: British Columbia Children's Hospital, A234-4480 Oak Street, Vancouver, BC, V6H3V4, Canada.
authors.forename: Firoz
authors.initials: F
authors.lastname: Miyanji
authors.affiliation: Shriners Hospitals for Children, Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.affiliation: Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.affiliation: Institute for Spine and Scoliosis, Lawrenceville, NJ, 08648, USA.
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.affiliation: Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Cahill
authors.affiliation: Johns Hopkins Hospital, 601 North Caroline Street, #5212, Baltimore, MD, 21287, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D007738:Kyphosis / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods
keywords: Cerebral palsy; Perioperative complications; Spinal fusion