Predicting Short-term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis

Study Design. A retrospective cohort study. Objective. The aim of this study was to determine the incidence and risk factors for short-term morbidity following posterior spinal fusion (PSF) for neuromuscular scoliosis (NMS). Summary of Background Data. NMS is a challenging spinal deformity for which PSF is often recommended. There is a lack of information on risk factors for short-term adverse outcomes after PSF for NMS. Methods. Patients who underwent PSF for NMS during 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database. Patient characteristics were tested for association with adverse events, infectious complications, extended length of stay (LOS), and readmission using multivariate regression. Results. Of the 940 NMS patients identified, 133 (14.1%) had an adverse event and 99 (10.5%) had a severe adverse event. American Society of Anesthesiologists (ASA) classification >= 3 was found to be the only independent risk factor for any adverse event (relative risk [RR] 2.2, P = 0.012) and severe adverse events (RR 2.5, P = 0.008). Infectious complications were associated with body mass index (BMI)-for-age >= 95th percentile (RR 2.8, P = 0.005), ASA classification >= 3 (RR 5.9, P = 0.003), and instrumentation to the pelvis (RR 1.8, P = 0.039). A total of 254 patients (27%) spent longer than a week in the hospital postoperatively, and ASA classification >= 3 (RR 2.3, P<0.001), preoperative seizure disorder (RR 1.4, P = 0.002), previous cardiac surgery (RR 1.6, P = 0.004), operative time >= 470 minutes (RR 1.8, P<0.001), and >= 13 levels instrumented (RR 1.9, P = 0.001) were associated with extended LOS. Seventy-six patients (8.1%) were readmitted, and BMI-for-age >= 95th percentile (RR 1.8, P = 0.033) was the only risk factor found for readmission. Conclusion. The identified factors associated with poor short-term outcomes after PSF for NMS can be used as benchmark data, be useful for optimizing patient care, and can inform future studies in these patients.