Comorbidities and Complications of Spinal Fusion for Scoliosis.
OBJECTIVE
General pediatricians and hospitalists are increasingly summoned to optimize the comorbid conditions of children with medical complexity (CMC) undergoing major surgery. We assessed the relationship between specific chronic conditions of CMC and hospital resource use with spinal fusion for scoliosis, an operation with high cost and morbidity.


METHODS
Retrospective analysis of 7252 children age ≥5 years with an underlying complex chronic condition undergoing spinal fusion between January 1, 2010 through December 31, 2014 in 41 children's hospitals. Hospital length of stay (LOS), cost, and 30-day readmission rate were compared across comorbid conditions by using linear and logistic regression accounting for demographic characteristics and clustering of patients by hospital.


RESULTS
Fifty-nine percent of children had ≥4 comorbid conditions. As the number of chronic conditions increased from 1-3 to ≥10, median LOS increased 60% (5 [interquartile range (IQR), 4-7] to 8 [IQR, 5-13] days); median hospital cost increased 53% ($52 319 [IQR, $37 937-71 513] to $80 429 [IQR, $58 602-$111 965]); and readmission rates increased 293% (5.4% to 15.8%) (P< .001 for all). In multivariable analysis, conditions strongly associated with LOS and cost were chronic respiratory insufficiency (LOS: +2.1 days; cost: +$12 070; and bladder dysfunction (LOS: +0.8 days; cost: +$4014) (P< .001 for all). Readmission likelihood was highest with bladder dysfunction (odds ratio, 1.5; 95% confidence interval, 1.1-2.0) and epilepsy (odds ratio, 1.2; 95% confidence interval, 1.0-1.5).


CONCLUSIONS
Chronic respiratory insufficiency, bladder dysfunction, and epilepsy had significant associations with hospital resource use for CMC undergoing spinal fusion. Pediatricians, patients, and families may find it useful to consider these conditions when striving to benefit the children's perioperative health and outcomes.
Complex Care Service, Division of General Pediatrics, Department of Medicine, jay.berry@childrens.harvard.edu.
Jay G
JG
Berry
Division of Orthopedic Surgery, Department of Surgery, and.
Michael
M
Glotzbecker
Children's Hospital Association, Overland Park, Kansas.
Jonathan
J
Rodean
Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and.
Izabela
I
Leahy
Children's Hospital Association, Overland Park, Kansas.
Matt
M
Hall
Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and.
Lynne
L
Ferrari
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004827:Epilepsy / Q000191:economics / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000191:economics / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion; D014481:United States / Q000453:epidemiology; D001745:Urinary Bladder Diseases / Q000191:economics / Q000453:epidemiology; D055815:Young Adult