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. 2025 Jun 23.
doi: 10.1007/s43390-025-01129-5. Online ahead of print.

Assessing malnutrition in cerebral palsy patients and its impact on complications following spinal fusion

Haseeb E Goheer  1 , Phillip T Yang  1 , Yasmine S Ghattas  1 , Gabriel Ramirez  1 , Ram Haddas  1 , Andrew G Dubina  1 , Susan E Nelson  1 , Varun Puvanesarajah  2
Affiliations

Assessing malnutrition in cerebral palsy patients and its impact on complications following spinal fusion

Haseeb E Goheer et al. Spine Deform. .

Abstract

Background: Cerebral palsy (CP) patients with severe scoliosis are frequently malnourished. However, there is a paucity of literature focusing on the impact of pediatric malnutrition indicators on post-operative surgical complications. This study aims to examine the relationship between measures of nutritional status and their ability to predict post-operative complications in patients with CP undergoing spinal fusion for neuromuscular scoliosis.

Methods: The American College of Surgeons National Surgical Quality Improvement Program Pediatric was queried retrospectively to identify pediatric CP patients who had undergone spinal fusions for neuromuscular scoliosis between 2016 and 2022 using the Current Procedural Terminology Code 22804. Univariate and multivariate regression were employed to assess differences in preoperative patient characteristics as well as postoperative complications across malnutrition definitions (stunting, wasting, and requiring nutritional support).

Results: A total of 2017 patients were identified between 2016 and 2022, of which 1124 received nutritional support and 893 did not. Among all patients, 93.3% (n = 1882) met at least one definition of malnutrition, 58.1% (n = 1172) met two or more definitions, and 9.3% (n = 187) met all three definitions of malnutrition. After adjustment, requiring nutritional support independently increased the risk for an extended intensive care unit stay (OR:1.35; 95 CI [1.01-1.83]; p = 0.047). Wasting independently increased the risk for unplanned intubation (OR:1.77; 95 CI [1.02-3.02]; p = 0.038) while stunting increased the risk for deep/organ space surgical site infection (OR:2.50; 95 CI [1.20-6.10]; p = 0.025).

Conclusion: Patients with malnutrition (defined as nutritional support) are at increased risk for an extended intensive unit care stay in the postoperative period. Personalized postoperative management with multidisciplinary teams, guided by risk assessment, may help mitigate postoperative complications and address the challenges associated with malnutrition.

Level of evidence: III.

Keywords: Cerebral Palsy; Complications; Malnutrition; Pediatrics; Scoliosis; Spine Deformity.

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Conflict of interest statement

Declarations. Conflicts of interest: HEG, PTY, YSG, GR, AGD, SEN, and VP have nothing to disclose. RH is a paid consultant for Medtronic and receives grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Scoliosis Research Society, Medtronic, and Zimmer Biomed. IRB statement: The study received Institutional Review Board approval under Study Protocol #00009804.

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