Intra-operative Neurophysiologic Monitoring in Pediatric Spinal Surgery: Utilization and Associated Costs

Introduction: Intraoperative neurophysiologic monitoring (IONM) is commonly utilized in spine surgery to limit and prevent injury. IONM allows surgeons to rapidly identify potential spinal cord injuries and work quickly to limit potential long-term injury. Currently, IONM studies utilizing national administrative databases focus on the adult population, with minimal attention to the pediatric population. The objective of this study was to identify the current trends and associated costs in the utilization of intraoperative neurophysiologic monitoring in pediatric scoliosis procedures.

Methods: We queried data from the 2016 Kid’s Inpatient Database (KID) to identify all patients undergoing spinal procedures for scoliosis. Cases utilizing IONM were identified by querying the KID and extracting hospital admissions data using ICD coding. Detailed patient characteristics were analyzed, and in-hospital morbidity and mortality rates were obtained. Multivariate linear regression was performed to describe predictors of length of stay.

Results: 2,598 pediatric patients undergoing scoliosis surgery with IONM and 6,197 without IONM were identified. The majority of patients in both cohorts were white with private insurance. Total charges were higher in the IONM group at $204,720 vs $171,225 in the non-IONM group. Additionally, the overall complication rate was lower in the IONM group at 15.2% compared to 19.1% in the non-IONM group. The rate of in-hospital pulmonary complications, respiratory complications, cardiac complications, wound complications, surgical site infections, and overall length of stay were all lower in the IONM cohort.

Conclusion : Utilization of IONM in pediatric scoliosis surgery has significantly increased since the introduction of its ICD code in 2007, however IONM usage is still not universal. Overall, we hope these data may be used in risk assessment prior to operation and as a baseline for outcomes comparisons amongst institutions.