Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample

Abstract

OBJECTIVE The aim of this study was to investigate the incidence of and factors associated with complications following idiopathic scoliosis surgery in adolescents. METHODS The Nationwide Inpatient Sample database was used to identify patients 10-18 years of age who had undergone spinal fusion for adolescent idiopathic scoliosis (AIS) from 2002 to 2011. Twenty-three unique in-hospital postoperative complications, including death, were examined. A series of logistic regressions was used to determine if any demographic, comorbid, or surgical parameter was associated with complication development. Results of multiple logistic regression analyses were reported as odds ratios with 95% confidence intervals. All analyses were performed after the application of discharge weights to produce national estimates. RESULTS A total of 36,335 patients met the study inclusion criteria, 7.6% of whom (95% CI 6.3%-8.9%) developed at least one in-hospital complication. The 3 most common complications were respiratory failure (3.47%), reintubation (1.27%), and implant related (1.14%). Major complications such as death, pancreatitis, disseminated intravascular coagulation, visual loss, spinal cord injury, cardiac arrest, sepsis, nerve root injury, deep vein thrombosis, pulmonary embolism, shock, malignant hyperthermia, myocardial infarction, and iatrogenic stroke each had an incidence ≤ 0.2%. On multiple logistic regression analysis, an increasing age (OR 0.80) was associated with significantly lower odds of complication development; patients who were male (OR 1.80) or who had anemia (OR 2.10), hypertension (OR 2.51), or hypothyroidism (OR 2.27) or underwent revision procedures (OR 5.55) were at a significantly increased risk for complication development. The rates of postoperative complications for posterior, anterior, and combined approaches were 6.7%, 10.0%, and 19.8%, respectively (p < 0.001). Length of fusion (< 8 vs ≥ 8 levels) was not associated with complication development (p = 0.311). CONCLUSIONS Analysis of 36,335 patients who had undergone surgery for AIS revealed that younger patients, male patients, patients with a history of anemia, hypertension, or hypothyroidism, as well as those undergoing revision or anterior or combined approaches may have higher rates of postoperative complications. However, the overall complication rate was low (7.6%), and major complications had a rate ≤ 0.2% for each event. These findings suggest that surgery for AIS remains relatively safe, and future prospective investigations may further help to decrease the postoperative morbidity rate.

Rapidly increasing incidence in scoliosis surgery over 14 years in a nationwide sample

“…These results mirror findings from other large population-based research demonstrating significant reductions in hospital LOS [7,8,17,20]. Vigneswaran et al in a study of surgical outcomes in individuals with idiopathic scoliosis, reported a decrease in average hospital LOS from 6.5 days in 1997 to 5.6 days in 2012 [8], which does not seem to be associated with higher complication rates [21].…”

“…These deaths occurred only in patients with non-idiopathic scoliosis (n = 655) [29]. De la Garza Ramos (2016) found a seemingly high mortality rate of 0.12% among 36,335 individuals with adolescent idiopathic scoliosis during the inpatient stay [20]. In our study there were no deaths among individuals with adolescent idiopathic scoliosis.…”

In-hospital mortality and morbidity of pediatric scoliosis surgery in Japan

“…The morbidity rate was 2.9% in the present study, which was lower than those in previous studies, ranging from 3.7% to 14.9%. [ 8 – 12 , 14 ] This discrepancy possibly arose through underestimation in the present study, because mild complications might have been underreported in the database as is reported in other studies utilizing the same database. [ 19 – 21 ]…”

“…This study identified several predictive factors for postoperative complications, including male sex, comorbid diabetes, and use of allogeneic blood transfusion. De la Garza Ramos et al [ 12 , 13 ] reported that male sex was a risk factor for postoperative complications in pediatric fusion surgery. Roddy and Diab [ 22 ] revealed that unplanned readmission after fusion for pediatric spinal deformity was significantly higher in male patients.…”

“…The ratio of male-to-female patients in the present study was comparable with those in previous studies. [ 12 , 13 , 22 ]…”