Does Reoperation Risk Vary for Different Types of Pediatric Scoliosis?
METHODS
Retrospective cohort study of spine fusion surgery utilizing the New York State Inpatient Database.


OBJECTIVE
The objective was to determine whether there were differences in reoperation rates among pediatric scoliosis associated with various etiologies compared with idiopathic scoliosis.


BACKGROUND
The incidence of postoperative complications and reoperations is known to vary among patients with diverse scoliosis pathologies. As these are heterogeneous conditions and often with rare occurrence, it is difficult to compare them in a single study. We aimed to assess reoperation events after fusion for several etiologies of pediatric scoliosis.


METHODS
The 2008 to 2011 New York State Inpatient Database was queried using International Classification of Diseases (ICD-9-CM) codes for patients with in-hospital stays including a spine arthrodesis for scoliosis. All approaches, all fusion lengths, and ages 10 to 21 were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated for several rare conditions associated with scoliosis.


RESULTS
Two thousand three hundred fifty-six pediatric scoliosis fusion surgeries were identified in 2008 in the state of New York. The 1- and 4-year reoperation rate for idiopathic scoliosis was 0.9% and 1.6%, respectively. For nonidiopathic scoliosis, the 1- and 4-year rates were 4.2% and 20.4%, respectively. Of the nonidiopathic scoliosis subtypes, congenital scoliosis (4.7% risk at 1 y, 41.6% at 4 y), the neuromuscular disease arthrogryposis (7.3% risk at 1 y, 28.6% at 4 y), and syndrome neurofibromatosis (9.1% at 1 y, 32.3% at 4 y) showed the highest risk for reoperation. Length of stay and hospital charges were higher for reoperations.


CONCLUSIONS
Using a large administrative database, we identified neuromuscular, syndromic, and congenital forms of scoliosis that have the highest relative risk for a reoperation within 1 year. At-risk populations should be identified and resources allocated and preventative measures instituted accordingly to prevent these costly events.


METHODS
Level III.
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases.
Justin C
JC
Paul
Department of Orthopaedic Surgery, Division of Spine Surgery, Mount Sinai Beth Israel, New York, NY.
Baron S
BS
Lonner
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases.
Shaleen
S
Vira
The Paley Institute, St Mary's Medical Center, West Palm Beach, FL.
David
D
Feldman
Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases.
Thomas J
TJ
Errico
D000293:Adolescent; D001176:Arthrogryposis / Q000453:epidemiology / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017253:Neurofibromatoses / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000145:classification / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000706:statistics & numerical data*