Predicting Short-term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis.
METHODS
A retrospective cohort study.


OBJECTIVE
The aim of this study was to determine the incidence and risk factors for short-term morbidity following posterior spinal fusion (PSF) for neuromuscular scoliosis (NMS).


BACKGROUND
NMS is a challenging spinal deformity for which PSF is often recommended. There is a lack of information on risk factors for short-term adverse outcomes after PSF for NMS.


METHODS
Patients who underwent PSF for NMS during 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database. Patient characteristics were tested for association with adverse events, infectious complications, extended length of stay (LOS), and readmission using multivariate regression.


RESULTS
Of the 940 NMS patients identified, 133 (14.1%) had an adverse event and 99 (10.5%) had a severe adverse event. American Society of Anesthesiologists (ASA) classification ≥3 was found to be the only independent risk factor for any adverse event (relative risk [RR] 2.2, P = 0.012) and severe adverse events (RR 2.5, P = 0.008). Infectious complications were associated with body mass index (BMI)-for-age ≥95th percentile (RR 2.8, P = 0.005), ASA classification ≥3 (RR 5.9, P = 0.003), and instrumentation to the pelvis (RR 1.8, P = 0.039).A total of 254 patients (27%) spent longer than a week in the hospital postoperatively, and ASA classification ≥3 (RR 2.3, P < 0.001), preoperative seizure disorder (RR 1.4, P = 0.002), previous cardiac surgery (RR 1.6, P = 0.004), operative time ≥470 minutes (RR 1.8, P < 0.001), and ≥13 levels instrumented (RR 1.9, P = 0.001) were associated with extended LOS.Seventy-six patients (8.1%) were readmitted, and BMI-for-age ≥95th percentile (RR 1.8, P = 0.033) was the only risk factor found for readmission.


CONCLUSIONS
The identified factors associated with poor short-term outcomes after PSF for NMS can be used as benchmark data, be useful for optimizing patient care, and can inform future studies in these patients.


METHODS
3.
*Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois†Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Bryce A
BA
Basques
Sophie H
SH
Chung
Adam M
AM
Lukasiewicz
Matthew L
ML
Webb
Andre M
AM
Samuel
Daniel D
DD
Bohl
Brian G
BG
Smith
Jonathan N
JN
Grauer
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data*