Pediatric Deformity Spinal Surgery Short-term Morbidity and Readmission Risk Factors- NSQIP Pediatric Database Analysis

Introduction: Pediatric spinal deformities put children at risk for limited function and quality of life. Spinal fusion has become the primary treatment for most of these spinal deformities. We present a multiyear database analysis looking at complications, readmissions, and predictors of morbidity. The objective of this analysis was to identify the incidence and risk factors for 30-day complications following pediatric deformity spinal surgery with the latest available data.

Methods: We queried data from the American College of Surgeons NSQIP-Pediatric database years 2013-2018 to identify all patients undergoing spinal fusion. Patients were categorized into diagnosis categories (congenital, idiopathic, infantile, neuromuscular, and other) based on ICD coding. Patient characteristics were analyzed, and 30-day complication and readmission rates were obtained. Univariate and multivariate regressions were utilized to identify variables predictive of complication.

Results: 21,264 pediatric patients undergoing spinal deformity surgery were identified. The rate of 30-day complications was 7.11%; with a mortality rate of 0.08%, a morbidity rate of 5.45%, unplanned reoperation rate of 2.73%, and a readmission rate of 3.49%. The morbidity rate was highest in the neuromuscular diagnosis group. The greatest risk factors for complication included ASA classification 3/4, requiring oxygen support, having a preexisting seizure disorder, having a congenital malformation, requiring nutritional support, having a preexisting neuromuscular disorder, and increased operative time. Readmissions were involved in 49% of complications. Surgical site infections caused 19%, GI complications caused 13%, and neurological/implant complications caused 8% of readmissions.

Conclusion : The overall incidence of 30-day complications following pediatric spinal deformity surgery was 7.11%. Both patient factors and surgical factors were found to be associated with increased complication risk. These data may be used in risk assessment prior to operation and as a baseline for outcomes comparisons amongst institutions routinely performing pediatric deformity spinal surgery.