Spinal fusion in pediatric patients with marfan syndrome: a nationwide assessment on short-term outcomes and readmission risk.
Complicaitons
Marfan syndrome
Readmission
Scoliosis
Spinal fusion
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
25
06
2020
accepted:
13
10
2020
revised:
01
09
2020
pubmed:
21
10
2020
medline:
6
7
2021
entrez:
20
10
2020
Statut:
ppublish
Résumé
The purpose of this study was to utilize the National Readmission Database (NRD) to determine estimates for complication rates, 90-day readmission rates, and hospital costs associated with spinal fusion in pediatric patients with Marfan syndrome. The 2012-2015 NRD databases were queried for all pediatric (< 19 years old) patients diagnosed with Marfan syndrome undergoing spinal fusion surgery. The primary outcome variables in this study were index admission complications and 90-day readmissions. A total of 249 patients with Marfan syndrome underwent spinal fusion surgery between 2012 and 2015 (mean age ± standard deviation at the time of surgery: 14 ± 2.0, 132 (53%) female). 25 (10.1%) were readmitted within 90 days of the index hospital discharge date. Overall, 59.7% of patients experienced at least one complication during the index admission. Unplanned 90-day readmission could be predicted by older age (odds ratio 2.3, 95% confidence interval 1.3-4.2, p = 0.006), Medicaid insurance status (56.0, 3.8-820.0, p = 0.003), and experiencing an inpatient medical complication (42.9, 4.6-398.7, p = 0.001). Patients were readmitted for wound dehiscence (8 patients, 3.2%), nervous system related complications (3 patients, 1.2%), and postoperative infectious related complications (4 patients, 1.6%). This study is the first to demonstrate on a national level the complications and potential risk factors for 90-day hospital readmission for patients with Marfan syndrome undergoing spinal fusion. Patients with Marfan syndrome undergoing spinal fusion often present with multiple medical comorbidities that must be managed carefully perioperatively to reduce inpatient complications and early hospital readmissions.
Identifiants
pubmed: 33078267
doi: 10.1007/s00586-020-06645-8
pii: 10.1007/s00586-020-06645-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
775-787Références
Judge DP, Dietz HC (2005) Marfan’s syndrome. Lancet 12:1965–1976. https://doi.org/10.1016/S0140-6736(05)67789-6
doi: 10.1016/S0140-6736(05)67789-6
Pyeritz RE, McKusick VA (1979) The marfan syndrome: diagnosis and management. N Engl J Med 300:772–777. https://doi.org/10.1056/NEJM197904053001406
doi: 10.1056/NEJM197904053001406
pubmed: 370588
MagotteauxBulkFarhatSakalihasanDefraigneSeghaye SSNNJOMC (2016) Marfan syndrome in childhood, adolescence. Rev Med Liege 71(7–8):342–348
Sponseller PD, Hobbs W, Riley LH III, Pyeritz RE (1995) The thoracolumbar spine in marfan syndrome. J Bone Jt Surg Am. 77:867–76
doi: 10.2106/00004623-199506000-00007
Keech MK, Wendt VE, Read RC, Bistue AR, Bianchi FA (1966) Family studies of the marfan syndrome. J Chronic Dis 19:57–58. https://doi.org/10.1016/0021-9681(66)90151-2
doi: 10.1016/0021-9681(66)90151-2
pubmed: 5903855
Birch JG, John AH (1987) Spinal deformity in Marfan syndrome. J Pediatr Orthop 7:546–552
doi: 10.1097/01241398-198709000-00009
Robins PR, Moe JH, Winter RB (1975) Scoliosis in Marfan’s syndrome. Its characteristics and results of treatment in thirty-five patients. J Bone Jt Surg Am 57(3):358–368
doi: 10.2106/00004623-197557030-00014
Jones KB, Erkula G, Sponseller PD, Dormans JP (2002a) Spine deformity correction in Marfan syndrome. Spine 27:2003–12
doi: 10.1097/00007632-200209150-00008
Demetracopoulos CA, Sponseller PD (2007) Spinal deformities in Marfan syndrome. Orthop Clin North Am 38:563–572. https://doi.org/10.1016/j.ocl.2007.04.003
doi: 10.1016/j.ocl.2007.04.003
pubmed: 17945136
Zuckerman RB, Sheingold SH, Orav EJ, Ruhter J, Epstein AM (2016) Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med 374:1543–1551. https://doi.org/10.1056/NEJMsa1513024
doi: 10.1056/NEJMsa1513024
pubmed: 26910198
NRD Overview (n.d.) https://www.hcup-us.ahrq.gov/nrdoverview.jsp . Accessed 3 Feb 2020
Passias PG, Poorman GW, Jalai CM, Neuman B, De La Garza-Ramos R, Miller E, Jain A, Sciubba D, McClelland S, Day L, Ramchandran S, Vira S, Diebo B, Isaacs E, Bono O, Bess S, Gerling M, Lafage V (2017) Morbidity of adult spinal deformity surgery in elderly has declined over time. Spine (Phila. Pa. 1976) 42:E978–E982. https://doi.org/10.1097/BRS.0000000000002009
doi: 10.1097/BRS.0000000000002009
Lee NJ, Guzman JZ, Kim J, Skovrlj B, Martin CT, Pugely AJ, Gao Y, Caridi JM, Mendoza-Lattes S, Cho SK (2016) A Comparative Analysis Among the SRS M&M NIS, and KID Databases for the Adolescent Idiopathic Scoliosis. Spine Deform 4:420–424. https://doi.org/10.1016/j.jspd.2016.05.005
doi: 10.1016/j.jspd.2016.05.005
pubmed: 27927571
Roddy E, Diab M (2017a) Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity. Spine J 17:369–379. https://doi.org/10.1016/j.spinee.2016.10.008
doi: 10.1016/j.spinee.2016.10.008
pubmed: 27765710
Jain A, Puvanesarajah V, Menga EN, Sponseller PD (2015) Unplanned Hospital Readmissions and Reoperations After Pediatric Spinal Fusion Surgery. Spine (Phila. Pa. 1976) 40:856–862. https://doi.org/10.1097/BRS.0000000000000857
doi: 10.1097/BRS.0000000000000857
Gjolaj JP, Sponseller PD, Shah SA, Newton PO, Flynn JM, Neubauer PR, Marks MC, Bastrom TP (2012) Spinal deformity correction in Marfan syndrome versus adolescent idiopathic scoliosis: Learning from the differences. Spine (Phila. Pa. 1976) 37:1558–1565. https://doi.org/10.1097/BRS.0b013e3182541af3
doi: 10.1097/BRS.0b013e3182541af3
Li Z, Shen J, Qiu G, Yu H, Wang Y, Zhang J, Zhao H, Zhao Y, Li S, Weng X, Liang J, Zhao L (2014) Unplanned reoperation within 30 days of fusion surgery for spinal deformity. PLoS One 9:e87172. https://doi.org/10.1371/journal.pone.0087172
doi: 10.1371/journal.pone.0087172
pubmed: 24595145
pmcid: 3942308
Golladay ES, Char FL, Mollitt DL (1985) Children with Marfan’s syndrome and pectus excavatum. South Med J 78(11):1319–23
doi: 10.1097/00007611-198511000-00012
Arn PH, Scherer LR, Haller JAJ, Pyeritz RE (1989) Outcome of pectus excavatum in patients with Marfan syndrome and in the general population. J Pediatr 115:954–958
doi: 10.1016/S0022-3476(89)80749-8
Redlinger RE, Rushing GD, Moskowitz AD, Kelly RE, Nuss D, Kuhn A, Obermeyer RJ, Goretsky MJ (2010) Minimally invasive repair of pectus excavatum in patients with Marfan syndrome and marfanoid features. J Pediatr Surg 45:193–199. https://doi.org/10.1016/j.jpedsurg.2009.10.037
doi: 10.1016/j.jpedsurg.2009.10.037
pubmed: 20105603
Schairer WW, Carrer A, Deviren V, Hu SS, Takemoto S, Mummaneni P, Chou D, Ames C, Burch S, Tay B, Sawyer A, Berven SH (2013) Hospital readmission after spine fusion for adultspinal deformity. Spine (Phila. Pa. 1976) 38:1681–1689. https://doi.org/10.1097/BRS.0b013e31829c08c9
doi: 10.1097/BRS.0b013e31829c08c9
Roddy E, Diab M (2017b) Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity. Spine J 17:369–379. https://doi.org/10.1016/j.spinee.2016.10.008
doi: 10.1016/j.spinee.2016.10.008
pubmed: 27765710
Jones KB, Erkula G, Sponseller PD, Dormans JP (2002b) Spine deformity correction in Marfan syndrome. Spine 27:2003
doi: 10.1097/00007632-200209150-00008
Paul JC, Lonner BS, Vira S, Feldman D, Errico TJ (2018) Does reoperation risk vary for different types of pediatric scoliosis? J Pediatr Orthop 38:459–464. https://doi.org/10.1097/BPO.0000000000000850
doi: 10.1097/BPO.0000000000000850
pubmed: 27603188
Gott VL, Cameron DE, Alejo DE, Greene PS, Shake JG, Caparrelli DJ, Dietz HC (2002) Aortic root replacement in 271 Marfan patients: a 24-year experience. Ann Thorac Surg 73:438–443. https://doi.org/10.1016/S0003-4975(01)03336-7
doi: 10.1016/S0003-4975(01)03336-7
pubmed: 11845856
Thaku NA, Czerwein JK, Butera JN, Palumbo MA (2010) Perioperative Management of Chronic Anticoagulation in Ortho. JAAOS J Am Acad Orthop Surg 18:729–738
doi: 10.5435/00124635-201012000-00003
Biteker M, Tekkeşin AI, Can MM, Dayan A, Ilhan E, Türkmen FM (2012) Outcome of noncardiac and nonvascular surgery in patients with mechanical heart valves. Am J Cardiol 110:562–567. https://doi.org/10.1016/j.amjcard.2012.04.031
doi: 10.1016/j.amjcard.2012.04.031
pubmed: 22591673
Streeten EA, Murphy EA, Pyeritz RE (1987) Pulmonary function in the Marfan syndrome. Chest 91:408–412. https://doi.org/10.1378/chest.91.3.408
doi: 10.1378/chest.91.3.408
pubmed: 3816319
Wood JR, Bellamy D (1984) Pulmonary disease in patients with Marfan syndrome. Thorax 39:780–784. https://doi.org/10.1136/thx.39.10.780
doi: 10.1136/thx.39.10.780
pubmed: 6495247
pmcid: 459918
Quigley PM, Haller JA, Jelus KL, Laughlin GM, Marcus CL (1996) Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr 128:638–643. https://doi.org/10.1016/S0022-3476(96)80128-4
doi: 10.1016/S0022-3476(96)80128-4
pubmed: 8627435
Karpman C, Aughenbaugh GL, Ryu JH (2011) Pneumothorax and bullae in Marfan syndrome. Respiration 82:219–224. https://doi.org/10.1159/000322958
doi: 10.1159/000322958
pubmed: 21252480
Lawrence VA, Cornell JE, Smetana GW (2006) Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American college of physicians. Ann Intern Med 144:596–608. https://doi.org/10.7326/0003-4819-144-8-200604180-00011
doi: 10.7326/0003-4819-144-8-200604180-00011
pubmed: 16618957
Giampietro PF, Peterson M, Schneider R, Davis JG, Raggio C, Myers E, Burke SW, Boachie-Adjei O, Mueller CM (2003) Assessment of bone mineral density in adults and children with Marfan syndrome. Osteoporos Int 14:559–563. https://doi.org/10.1007/s00198-003-1433-0
doi: 10.1007/s00198-003-1433-0
pubmed: 12845424
Kohlmeier L, Gasner C, Bachrach LK, Marcus R (2009) The bone mineral status of patients with marfan syndrome. J Bone Miner Res 10:1550–1555. https://doi.org/10.1002/jbmr.5650101017
doi: 10.1002/jbmr.5650101017
Vitale MA, Arons RR, Hyman JE, Skaggs DL, Roye DP, Vitale MG (2005) The contribution of hospital volume, payer status, and other factors on the surgical outcomes of scoliosis patients: a review of 3,606 cases in the State of California. J Pediatr Orthop 25(3):393–399
doi: 10.1097/01.bpo.0000153880.05314.be
Boylan MR, Riesgo AM, Chu A, Paulino CB, Feldman DS (2019) Costs and complications of increased length of stay following adolescent idiopathic scoliosis surgery. J Pediatr Orthop Part B 28:27–31. https://doi.org/10.1097/BPB.0000000000000543
doi: 10.1097/BPB.0000000000000543
Imahiyerobo T, Minkara AA, Matsumoto H, Vitale MG (2018) Plastic multilayered closure in pediatric nonidiopathic scoliosis is associated with a lower than expected incidence of wound complications and surgical site infections. Spine Deform 6:454–459. https://doi.org/10.1016/j.jspd.2017.12.009
doi: 10.1016/j.jspd.2017.12.009
pubmed: 29886919