BACKGROUND: Posterior spinal fusion (PSF) is commonly performed for patients with adolescent idiopathic scoliosis (AIS). Identifying factors associated with perioperative morbidity and PSF may lead to strategies for reducing the frequency of adverse events (AEs) in patients and total hospital costs. QUESTIONS/PURPOSES: What is the frequency of and what factors are associated with postoperative: (1) AEs, (2) extended length of stay (LOS), and (3) readmission in patients with AIS undergoing PSF? PATIENTS AND METHODS: Patients, aged 11 to 18 years, who underwent PSF for AIS during 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) Pediatric database. Patient were assessed for characteristics associated with AEs, extended LOS (defined as more than 6 days), and hospital readmission using multivariate logistic regression. Individual AEs captured in the database were grouped into two categories, "any adverse event" (AAE) and "severe adverse events" (SAEs) for analysis. A total of 733 patients met inclusion criteria. RESULTS: Twenty-seven patients (3.7%) had AAE and 19 patients (2.6%) had SAEs. Both AAE and SAEs were associated with BMI-for-age ninety-fifth percentile or greater (AAE: odds ratio [OR], 3.31; 95% CI, 1.43-7.65; p=0.005. SAE: OR, 3.46; 95% CI, 1.32-9.09; p=0.012). Extended LOS occurred for 60 patients (8.2%) and was associated with greater than 13 levels instrumented (OR, 2.00; 95% CI, 1.11-3.61; p=0.021) and operative time of 365 minutes or more (OR, 2.57; 95% CI, 1.39-4.76; p=0.003). Readmission occurred for 11 patients (1.5%), most often for surgical site infection, and was associated with the occurrence of any complication during the initial hospital stay (OR, 180.44; 95% CI, 35.47-917.97; p<0.001). CONCLUSIONS: Further research on prevention and management of obesity and surgical site infections may reduce perioperative morbidity for patients with AIS undergoing PSF. LEVEL OF EVIDENCE: Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: Posterior spinal fusion (PSF) is commonly performed for patients with adolescent idiopathic scoliosis (AIS). Identifying factors associated with perioperative morbidity and PSF may lead to strategies for reducing the frequency of adverse events (AEs) in patients and total hospital costs. QUESTIONS/PURPOSES: What is the frequency of and what factors are associated with postoperative: (1) AEs, (2) extended length of stay (LOS), and (3) readmission in patients with AIS undergoing PSF? PATIENTS AND METHODS: Patients, aged 11 to 18 years, who underwent PSF for AIS during 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) Pediatric database. Patient were assessed for characteristics associated with AEs, extended LOS (defined as more than 6 days), and hospital readmission using multivariate logistic regression. Individual AEs captured in the database were grouped into two categories, "any adverse event" (AAE) and "severe adverse events" (SAEs) for analysis. A total of 733 patients met inclusion criteria. RESULTS: Twenty-seven patients (3.7%) had AAE and 19 patients (2.6%) had SAEs. Both AAE and SAEs were associated with BMI-for-age ninety-fifth percentile or greater (AAE: odds ratio [OR], 3.31; 95% CI, 1.43-7.65; p=0.005. SAE: OR, 3.46; 95% CI, 1.32-9.09; p=0.012). Extended LOS occurred for 60 patients (8.2%) and was associated with greater than 13 levels instrumented (OR, 2.00; 95% CI, 1.11-3.61; p=0.021) and operative time of 365 minutes or more (OR, 2.57; 95% CI, 1.39-4.76; p=0.003). Readmission occurred for 11 patients (1.5%), most often for surgical site infection, and was associated with the occurrence of any complication during the initial hospital stay (OR, 180.44; 95% CI, 35.47-917.97; p<0.001). CONCLUSIONS: Further research on prevention and management of obesity and surgical site infections may reduce perioperative morbidity for patients with AIS undergoing PSF. LEVEL OF EVIDENCE: Level III, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
Authors: Albert F Pull ter Gunne; Allard J F Hosman; David B Cohen; Michael Schuetz; Drmed Habil; Cees J H M van Laarhoven; Joost J van Middendorp Journal: Spine (Phila Pa 1976) Date: 2012-11-15 Impact factor: 3.468
Authors: Nanci Yuan; Javier A Fraire; Monique M Margetis; David L Skaggs; Vernon T Tolo; Thomas G Keens Journal: Spine (Phila Pa 1976) Date: 2005-10-01 Impact factor: 3.468
Authors: Roslyn C Tarrant; Sam Lynch; Padraig Sheeran; Padhraig F O'Loughlin; Michelle Harrington; David P Moore; Patrick J Kiely Journal: Spine (Phila Pa 1976) Date: 2014-01-15 Impact factor: 3.468
Authors: Firoz Miyanji; Gerard P Slobogean; Amer F Samdani; Randal R Betz; Christopher W Reilly; Bronwyn L Slobogean; Peter O Newton Journal: J Bone Joint Surg Am Date: 2012-05-02 Impact factor: 5.284
Authors: Jeffrey B Burnette; Edward Ebramzadeh; Jessica L Lee; Sue Galanti; M Mark Hoffer Journal: J Pediatr Orthop Date: 2004 Nov-Dec Impact factor: 2.324
Authors: Jeffrey L Zitsman; Thomas H Inge; Kirk W Reichard; Allen F Browne; Carroll M Harmon; Marc P Michalsky Journal: J Pediatr Surg Date: 2013-12-10 Impact factor: 2.545
Authors: Vidyadhar V Upasani; Christine Caltoum; Maty Petcharaporn; Tracey Bastrom; Jeff Pawelek; Michelle Marks; Randal R Betz; Lawrence G Lenke; Peter O Newton Journal: Spine (Phila Pa 1976) Date: 2008-02-01 Impact factor: 3.468
Authors: Jennifer M Bauer; Suken A Shah; Paul D Sponseller; Amer F Samdani; Peter O Newton; Michelle C Marks; Baron S Lonner; Burt Yaszay Journal: Spine Deform Date: 2020-07-27
Authors: Jakub Sikora-Klak; Vidyadhar V Upasani; Brice Ilharreborde; Madeline Cross; Tracey P Bastrom; Keyvan Mazda; Burt Yaszay; Peter O Newton Journal: Childs Nerv Syst Date: 2020-08-24 Impact factor: 1.475