title: Primary Versus Revision Spinal Fusion in Children: An Analysis of 74,525 Cases From the Nationwide Inpatient Sample.
abstract: METHODS
  Retrospective cohort study of a nationwide database.
  
  
  OBJECTIVE
  To compare in-hospital outcomes for pediatric patients who underwent primary versus revision spinal fusion.
  
  
  BACKGROUND
  There is limited data on outcomes after primary versus revision spinal fusion in children.
  
  
  METHODS
  Data from the Nationwide Inpatient Sample from 2002 to 2011 were analyzed. Pediatric patients (age <18 yr) who underwent ≥3 level spinal fusion were identified. Demographics, in-hospital complications, length of stay, and hospital charges were compared between primary and revision (refusion) procedures. All analyses were performed after application of discharge weights.
  
  
  RESULTS
  Data from 72,483 primary fusion and 2042 revision fusion procedures (2.7%) were analyzed. Average length of stay was 7.9 days for the revision group and 6.6 for the primary group (P = 0.022). Average total charges were $135,644 and $142,029 for the revision and primary fusion groups, respectively (P = 0.252). The percentage of patients who developed at least one in-hospital complication was 16.7% in the revision group and 8.6% in the primary fusion group (P < 0.001). Specific complications that were more common in the revision group were reintubation (4.3% vs. 2.3%, P = 0.008), hemorrhage/hematoma (5.0% vs. 2.5%, P = 0.001), wound complications (4.0% vs. 1.1%, P < 0.001), accidental vessel/nerve puncture (2.6% vs. 0.8%, P < 0.001), implant-related complications (5.3% vs. 0.4%, P < 0.001), and incidental durotomy (2.1% vs. 0.3%, P < 0.001). On multivariate analysis, revision procedures (odds ratio [OR] 2.64; 95% confidence interval [CI] 1.93-3.59; P < 0.001), male sex (OR 1.73; 95% CI 1.52-1.98; P < 0.001), and fusion of eight or more spinal levels (OR 1.27; 95% CI 1.09-1.47; P = 0.001) were risk factors for complication development.
  
  
  CONCLUSIONS
  In the present study, pediatric patients who underwent spinal refusion had significantly higher complication rates compared to patients who underwent primary fusion, consistent with previous investigations. Male patients and patients who underwent fusion of eight or more spinal levels also had higher complication rates.
  
  
  METHODS
  3.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza Ramos
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Taylor
authors.initials: T
authors.lastname: Purvis
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, NC.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.affiliation: Shriners Hospitals for Children, Philadelphia, PA.
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome