Amer F Samdani1, Eric J Belin2, James T Bennett3, Firoz Miyanji4, Joshua M Pahys5, Suken A Shah6, Peter O Newton7, Randal R Betz8, Patrick J Cahill9, Paul D Sponseller10. 1. Shriners Hospitals for Children, Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA. amersamdani@gmail.com. 2. Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, 21201, USA. 3. Department of Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, PA, 19140, USA. 4. British Columbia Children's Hospital, A234-4480 Oak Street, Vancouver, BC, V6H3V4, Canada. 5. Shriners Hospitals for Children, Philadelphia, 3551 North Broad Street, Philadelphia, PA, 19140, USA. 6. Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA. 7. Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA, 92123, USA. 8. Institute for Spine and Scoliosis, Lawrenceville, NJ, 08648, USA. 9. Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA. 10. Johns Hopkins Hospital, 601 North Caroline Street, #5212, Baltimore, MD, 21287, USA.
Abstract
PURPOSE: A prospective, longitudinal cohort was studied to determine the incidence, consequences, and risk factors of major perioperative complications in patients with cerebral palsy (CP) treated with spinal fusion. There is a wide variety of data available on the complications of spine surgery; however, little exists on the perioperative complications in patients with CP. METHODS: A prospective multicenter dataset of consecutive patients with CP treated with spinal fusion was evaluated. All major perioperative complications were identified and stratified into categories: pulmonary, gastrointestinal, other medical, wound infection, neurological, instrumentation related, and unplanned staged surgery. Univariate and multivariate analyses were performed to identify various risk factors for major perioperative complications. RESULTS: 127 patients were identified with a mean age of 14.3 ± 2.6 years. Overall, 39.4% of the patients had a major perioperative complication. Occurrence of a complication [no complication (NC), yes complication (YC)] resulted in significantly increased intensive care unit (ICU) (NC = 3.2 days, YC = 7.8 days, p < 0.05) and hospital stays (NC = 7.7 days, YC = 15.6 days, p < 0.05). Variables associated with greater risk of a complication included: increased estimated blood loss (EBL) (p < 0.001), larger preoperative kyphosis (p = 0.05), staged procedures (p < 0.05), a lack of antifibrinolytic use (p < 0.05), and a trend toward lower body mass index (BMI) (p = 0.08). Multivariate regression analysis revealed an increased EBL as independently associated with a major perioperative complication (p < 0.05). CONCLUSIONS: In this cohort of patients with CP who underwent spinal fusion, 39.4% experienced a major perioperative complication, with pulmonary being the most common. The occurrence of a major perioperative complication lengthened both ICU and hospital stay. Risk factors for major perioperative complications included greater preoperative kyphosis, staged procedures, a lack of antifibrinolytic use, and increased EBL, with the latter being an independent predictor of a major perioperative complication. LEVEL OF EVIDENCE: 2.
PURPOSE: A prospective, longitudinal cohort was studied to determine the incidence, consequences, and risk factors of major perioperative complications in patients with cerebral palsy (CP) treated with spinal fusion. There is a wide variety of data available on the complications of spine surgery; however, little exists on the perioperative complications in patients with CP. METHODS: A prospective multicenter dataset of consecutive patients with CP treated with spinal fusion was evaluated. All major perioperative complications were identified and stratified into categories: pulmonary, gastrointestinal, other medical, wound infection, neurological, instrumentation related, and unplanned staged surgery. Univariate and multivariate analyses were performed to identify various risk factors for major perioperative complications. RESULTS: 127 patients were identified with a mean age of 14.3 ± 2.6 years. Overall, 39.4% of the patients had a major perioperative complication. Occurrence of a complication [no complication (NC), yes complication (YC)] resulted in significantly increased intensive care unit (ICU) (NC = 3.2 days, YC = 7.8 days, p < 0.05) and hospital stays (NC = 7.7 days, YC = 15.6 days, p < 0.05). Variables associated with greater risk of a complication included: increased estimated blood loss (EBL) (p < 0.001), larger preoperative kyphosis (p = 0.05), staged procedures (p < 0.05), a lack of antifibrinolytic use (p < 0.05), and a trend toward lower body mass index (BMI) (p = 0.08). Multivariate regression analysis revealed an increased EBL as independently associated with a major perioperative complication (p < 0.05). CONCLUSIONS: In this cohort of patients with CP who underwent spinal fusion, 39.4% experienced a major perioperative complication, with pulmonary being the most common. The occurrence of a major perioperative complication lengthened both ICU and hospital stay. Risk factors for major perioperative complications included greater preoperative kyphosis, staged procedures, a lack of antifibrinolytic use, and increased EBL, with the latter being an independent predictor of a major perioperative complication. LEVEL OF EVIDENCE: 2.
Authors: Marco G A Teli; Pasquale Cinnella; Fiammetta Vincitorio; Alessio Lovi; Giuseppe Grava; Marco Brayda-Bruno Journal: Spine (Phila Pa 1976) Date: 2006-06-15 Impact factor: 3.468
Authors: Athanasios I Tsirikos; Wei-Ning Chang; Kirk W Dabney; Freeman Miller; Joseph Glutting Journal: Dev Med Child Neurol Date: 2003-10 Impact factor: 5.449
Authors: Paul D Sponseller; Suken A Shah; Mark F Abel; Daniel Sucato; Peter O Newton; Harry Shufflebarger; Lawrence G Lenke; Lynn Letko; Randal Betz; Michelle Marks; Tracey Bastrom Journal: Spine (Phila Pa 1976) Date: 2009-04-15 Impact factor: 3.468
Authors: Ignacio Rehbein; Viviana Teske; Ignacio Pagano; Alejandro Cúneo; María Elena Pérez; Johan von Heideken Journal: World J Orthop Date: 2020-04-18
Authors: Maximilian F Kasparek; Friedrich Boettner; Anna Rienmueller; Michael Weber; Philipp T Funovics; Petra Krepler; Reinhard Windhager; Josef Grohs Journal: Eur Spine J Date: 2018-07-28 Impact factor: 3.134
Authors: Arun R Hariharan; Suken A Shah; Paul D Sponseller; Burt Yaszay; Michael P Glotzbecker; George H Thompson; Patrick J Cahill; Tracey P Bastrom Journal: Spine Deform Date: 2022-09-26
Authors: Bram P Verhofste; Jay G Berry; Patricia E Miller; Charis N Crofton; Brigid M Garrity; Nicholas D Fletcher; Michelle C Marks; Suken A Shah; Peter O Newton; Amer F Samdani; Mark F Abel; Paul D Sponseller; Michael P Glotzbecker Journal: Spine Deform Date: 2020-11-17
Authors: Nathan J Lee; Michael Fields; Venkat Boddapati; Justin Mathew; Daniel Hong; Zeeshan M Sardar; Paulo R Selber; Benjamin Roye; Michael G Vitale; Lawrence G Lenke Journal: Global Spine J Date: 2020-09-23
Authors: Anoop R Galivanche; Stephen M Gillinov; Michael R Mercier; Christopher A Schneble; Arya G Varthi; Jonathan N Grauer; David B Frumberg Journal: N Am Spine Soc J Date: 2022-09-06