Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study with Minimum 2-year Follow-Up.

Adolescent Child Cohort Studies Female Follow-Up Studies Humans Incidence Japan / epidemiology Kyphosis / epidemiology Male Operating Rooms / trends Postoperative Complications / epidemiology Prostheses and Implants / adverse effects Reoperation / trends Retrospective Studies Risk Factors Scoliosis / epidemiology Spinal Fusion / adverse effects

Journal

Spine

ISSN: 1528-1159

Titre abrégé: Spine (Phila Pa 1976)

Pays: United States

ID NLM: 7610646

Informations de publication

Date de publication:
15 Apr 2021

Historique:

pubmed: 14 11 2020

medline: 26 5 2021

entrez: 13 11 2020

Statut: ppublish

Résumé

A retrospective multicenter cohort study. The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity. Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology. We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR. We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR. The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.

Sections du résumé

STUDY DESIGN METHODS

A retrospective multicenter cohort study.

OBJECTIVE OBJECTIVE

The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity.

SUMMARY OF BACKGROUND DATA BACKGROUND

Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology.

METHODS METHODS

We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR.

RESULTS RESULTS

We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR.

CONCLUSION CONCLUSIONS

The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.

Identifiants

DOI: 10.1097/BRS.0000000000003822 PMID: 33186273

pubmed: 33186273

pii: 00007632-202104150-00012

doi: 10.1097/BRS.0000000000003822

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

E498-E504

Informations de copyright

Références

Patil CG, Santarelli J, Lad SP, et al. Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective. Spine J 2008; 8:904–910.

Reames DL, Smith JS, Fu KM, et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 2011; 36:1484–1491.

Pugely AJ, Martin CT, Gao Y, et al. The incidence and risk factors for short-term morbidity and mortality in pediatric deformity spinal surgery: an analysis of the NSQIP pediatric database. Spine (Phila Pa 1976) 2014; 39:1225–1234.

Yoshihara H, Yoneoka D. National trends in spinal fusion for pediatric patients with idiopathic scoliosis: demographics, blood transfusions, and in-hospital outcomes. Spine (Phila Pa 1976) 2014; 39:1144–1150.

De la Garza Ramos R, Goodwin CR, Abu-Bonsrah N, et al. Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample. J Neurosurg Pediatr 2016; 18:730–736.

De la Garza Ramos R, Goodwin CR, Purvis T, et al. Primary versus revision spinal fusion in children: an analysis of 74,525 cases from the nationwide inpatient sample. Spine (Phila Pa 1976) 2017; 42:E660–E665.

Basques BA, Bohl DD, Golinvaux NS, et al. Patient factors are associated with poor short-term outcomes after posterior fusion for adolescent idiopathic scoliosis. Clin Orthop Relat Res 2015; 473:286–294.

Taniguchi Y, Oichi T, Ohya J, et al. In-hospital mortality and morbidity of pediatric scoliosis surgery in Japan: Analysis using a national inpatient database. Medicine (Baltimore) 2018; 97:e0277.

Birkmeyer JD, Hamby LS, Birkmeyer CM, et al. Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg 2001; 136:405–411.

Kroon HM, Breslau PJ, Lardenoye JW. Can the incidence of unplanned reoperations be used as an indicator of quality of care in surgery? Am J Med Qual 2007; 22:198–202.

Mukerji N, Jenkins A, Nicholson C, et al. Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator. J Neurosurg Pediatr 2012; 9:665–669.

Samdani AF, Belin EJ, Bennett JT, et al. Unplanned return to the operating room in patients with adolescent idiopathic scoliosis: are we doing better with pedicle screws? Spine (Phila Pa 1976) 2013; 38:1842–1847.

Ahmed SI, Bastrom TP, Yaszay B, et al. 5-Year reoperation risk and causes for revision after idiopathic scoliosis surgery. Spine (Phila Pa 1976) 2017; 42:999–1005.

Dannenbaum JH, Tompkins BJ, Bronson WB, et al. Secondary surgery rates after primary fusion surgery for adolescent idiopathic scoliosis. Orthopedics 2019; 42:235–239.

Luhmann SJ, Lenke LG, Bridwell KH, et al. Revision surgery after primary spine fusion for idiopathic scoliosis. Spine (Phila Pa 1976) 2009; 34:2191–2197.

Jain A, Puvanesarajah V, Menga EN, et al. Unplanned hospital readmissions and reoperations after pediatric spinal fusion surgery. Spine (Phila Pa 1976) 2015; 40:856–862.

Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery 2014; 74:112–120.

Williams BA, Matsumoto H, McCalla DJ, et al. Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am 2014; 96:1359–1367.

Lonner BS, Toombs CS, Guss M, et al. Complications in operative Scheuermann kyphosis: do the pitfalls differ from operative adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 2015; 40:305–311.

Toll BJ, Samdani AF, Janjua MB, et al. Perioperative complications and risk factors in neuromuscular scoliosis surgery. J Neurosurg Pediatr 2018; 22:207–213.

Paul JC, Lonner BS, Vira S, et al. Does reoperation risk vary for different types of pediatric scoliosis? J Pediatr Orthop 2018; 38:459–464.

Subramanyam R, Schaffzin J, Cudilo EM, et al. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. Spine J 2015; 15:1422–1431.

Mackenzie WG, Matsumoto H, Williams BA, et al. Surgical site infection following spinal instrumentation for scoliosis. J Bone Joint Surg Am 2013; 95:800–806.

Du JY, Poe-Kochert C, Thompson GH, et al. Risk factors for early infection in pediatric spinal deformity surgery: a multivariate analysis. Spine Deform 2019; 7:410–416.

Sullivan BT, Abousamra O, Puvanesarajah V, et al. Deep infections after pediatric spinal arthrodesis: differences exist with idiopathic, neuromuscular, or genetic and syndromic cause of deformity. J Bone Joint Surg Am 2019; 101:2219–2225.