The Incidence and Risk Factors for Short-term Morbidity and Mortality in Pediatric Deformity Spinal Surgery

Pugely, Andrew J.; Martin, Christopher T.; Gao, Yubo; Ilgenfritz, Ryan M.; Weinstein, Stuart L.

doi:10.1097/brs.0000000000000365

Cited by 73 publications

(54 citation statements)

References 34 publications

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“…3,7,9,49,59,60,61,71,77,90,91 Despite its utility in evaluating perioperative complications and adverse outcomes, few studies have used the NSQIP to analyze the outcomes of patients undergoing surgery for spinal tumors. The goal of this study was to evaluate the 30-day cumulative incidence, time to event, and predictors of major complications, unplanned reoperations, and readmissions after surgery for primary and secondary spinal tumors.…”

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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“…Several studies have also demonstrated that wound infections and wound dehiscence represent the most common complications following spinal arthrodesis in this population. 11,15,16 We found that the unplanned readmission and reoperation rates were 3.96% and 3.6%, respectively. Pugely et al 16 recently reported similar readmission (3.94%) and reoperation (3.74%) rates in patients undergoing arthrodesis for pediatric spinal deformities, and Minhas et al 15 reported a 30-day readmission rate of 3.4% in pediatric patients in the NSQIP database who underwent surgical treatment of pediatric scoliosis.…”

Section: Discussionmentioning

confidence: 83%

“…The values obtained for overall morbidity and mortality are comparable to those reported in the literature for pediatric patients undergoing spinal fusion, particularly for spinal deformity. 3,4,8,16,19 SSIs and wound dehiscence were the most common complications and also accounted for a majority of the indications for readmission and/or reoperations. Several studies have also demonstrated that wound infections and wound dehiscence represent the most common complications following spinal arthrodesis in this population.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,5,7,10,13,14,16,17,[23][24][25] Patients undergoing spinal arthrodesis are at significant risk for developing complications and having unplanned readmissions and/ or reoperations. These clinical outcomes are undesirable for patients, physicians, and the health care system in general, as they can result in increased cost and decreased quality of life.…”

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confidence: 99%

“…patients 1,2,7,16,17,[23][24][25] or a single complication, 5,10,[13][14][15] while others have been limited to single centers 5,7,9,10 or to the adult population. 7,18,20,21 Few studies have provided a comprehensive description of patient characteristics, operative factors, and comorbidities on short-term morbidity and mortality after spinal arthrodesis in children.…”

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confidence: 99%

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Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis

Abu-Bonsrah¹,

Goodwin

Ortega

et al. 2017

Neurosurgical Focus

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OBJECTIVESpinal arthrodesis is routinely performed in the pediatric population. However, there is limited information on the short-term outcomes of pediatric patients who have undergone spine fusion. Thus, the authors conducted a retrospective review of the Pediatric National Surgical Quality Improvement Program (NSQIP) database to determine the short-term mortality, complication, reoperation, and readmission rates of pediatric patients who underwent spinal arthrodesis for all indications.METHODSThe Pediatric NSQIP database was queried for all patients who underwent spinal arthrodesis between 2012 and 2014. Patient demographics, comorbidities, body mass index, American Society of Anesthesiologists classification, and operative time were abstracted. Short-term mortality, reoperation, and readmission rates and complications were also noted. Univariate and multivariate analyses were performed to delineate patient risk factors that influence short-term mortality, complications, reoperation, and readmission rates.RESULTSA total of 4420 pediatric patients who underwent spinal fusion were identified. Common indications for surgical intervention included acquired/idiopathic scoliosis or kyphoscoliosis (71.2%) and genetic/syndromic scoliosis (10.7%). The mean patient age was 13.7 ± 2.9 years, and 70% of patients were female. The overall 30-day mortality was 0.14%. Multivariate analysis showed that female sex and pulmonary comorbidities significantly increased the odds of reoperation, with odds ratios of 1.43 and 1.78, respectively.CONCLUSIONSIn the NSQIP database for pediatric patients undergoing spinal arthrodesis for all causes, there was a 3.6% unplanned reoperation rate, a 3.96% unplanned readmission rate, and a 9.0% complication rate. This analysis provides data for risk stratification of pediatric patients undergoing spinal arthrodesis, allowing for optimized care.

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Population‐based study of congenital heart disease and revisits after pediatric tonsillectomy

Miller

Tumin

McKee

et al. 2019

Laryngoscope Investig Oto

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Objective Accurate assessment of risk factors such as congenital heart disease (CHD) can aid in risk stratification of children presenting for surgery. Risk stratification is especially important in tonsillectomy ± adenoidectomy (T/A), a common pediatric procedure that is usually performed electively, but that has a high rate of adverse events. In this study, we examined the association of CHD with revisits after T/A. Methods We identified children who underwent T/A at hospitals and hospital‐owned facilities during 2010 to 2014 using the State Inpatient Databases and State Ambulatory Surgery and Services Databases of Florida, Georgia, Iowa, New York, and Utah. We evaluated the association between CHD severity and the occurrence of an unplanned hospital readmission or ED visit within 30 days following discharge using multivariable logistic regression. Results The analysis included 244,598 patients, of whom 858 had minor or major CHD. In multivariable analysis, CHD was not associated with an increased risk of 30‐day revisits (minor OR = 1.1; 95% CI: 0.8, 1.5; P = .65; major OR = 1.2; 95% CI: 0.9, 1.6; P = .34). Other comorbidities, including chromosomal anomalies (OR = 1.4; 95% CI: 1.2, 1.6; P < .001), congenital airway anomalies (OR = 1.3; 95% CI: 1.03, 1.7; P = .03), and neuromuscular impairment (OR = 1.4; 95% CI: 1.2, 1.7; P < .001) predicted an increased likelihood of revisits. Conclusion Neither minor nor major CHD was independently associated with an increased risk of 30‐day revisits among children undergoing T/A. Other characteristics, particularly non‐cardiac comorbidities, socioeconomic status, and geographic region may be of greater utility for predicting revisit risk following pediatric T/A. Level of Evidence 2b

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The Incidence and Risk Factors for Short-term Morbidity and Mortality in Pediatric Deformity Spinal Surgery

Abstract: 2.

Cited by 73 publications

References 34 publications

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis

Population‐based study of congenital heart disease and revisits after pediatric tonsillectomy

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