Factors associated with immediate post-operative complications in pediatric patients in intensive care after spinal deformity surgical repair

Abstract

Background: Surgical repair is a widely used and effective treatment for pediatric scoliosis, significantly improving patients' quality of life. However, despite the overall safety of these procedures, postoperative complications can occur, presenting notable challenges. To ensure optimal monitoring and management, pediatric scoliosis patients are frequently admitted to the pediatric intensive care unit (PICU) during the immediate postoperative period. This study aimed to identify patient characteristics associated with immediate postoperative complications within the first 48 h following spinal deformity surgery. Furthermore, it sought to evaluate the types, prevalence, and severity of these complications, as well as the risk factors contributing to their development.

Methods: A retrospective cohort study was conducted, encompassing all children aged 8 to 18 years who underwent spinal deformity surgery and were admitted to the largest tertiary pediatric intensive care unit (PICU) in Israel between 2010 and 2021. Clinical and laboratory data were extracted from electronic medical records and systematically analyzed. Statistical analyses were performed to identify risk factors associated with immediate postoperative complications occurring within the first 48 h after surgery.

Results: The study included 81 pediatric patients who underwent spinal deformity surgery. Of these, 41 (50%) experienced complications within the first 48 h post-surgery. Patients with comorbidities demonstrated a higher prevalence of complications (RR = 1.8; 95% CI = 1.12-2.91). A significantly increased risk of hemodynamic complications was observed in patients with serum lactate levels above 2 mmol/L upon PICU admission (RR = 7.3; 95% CI = 2.45-21.79) and in those with a significant decrease in hemoglobin levels (RR = 4.56; 95% CI = 1.76-11.83). Additionally, patients with CRP levels above 20 mg/dL or albumin levels below 3 mg/dL upon admission had significantly higher relative risks of general complications (RR = 1.71; 95% CI = 1.12-2.63 and RR = 1.57; 95% CI = 1.06-2.32, respectively). A predictive model for significant complications in pediatric patients following spinal deformity surgery was developed based on these factors. The model was able to predict possible immediate complications with an AUC of 0.74 and with scores above 4 points demonstrated 100% specificity and 100% positive predictive value in identifying complications at the time of PICU admission. Using this model, we effectively stratified patients into low-risk and high-risk groups for postoperative complications.

Conclusion: We identified several factors associated with an increased risk of complications within 48 h following pediatric spinal deformity surgery. A simple and easy to use predictive model developed using these factors demonstrated good performance allowing stratification of patients upon admission to the PICU. The ability to screen patients for complications early in the course of their PICU stay, offers the potential to improve care, reduce unnecessary PICU admissions, lower healthcare costs, and shorten hospital stays. However, further research is essential to validate and refine the model to enhance its effectiveness and broader applicability.

Keywords: Complications; Pediatric intensive care; Scoliosis; Spinal deformity; Surgical repair.