Patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis

Abstract

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.

Fig. 1

Distribution of BMI for study patient population is shown.

Fig. 2

Postoperative LOS* after PSF in patients with AIS is shown. *Extended LOS defined as > 90th percentile LOS or 6 days. Patients to the right of the dashed vertical line had extended LOS.