Abstract
Study design
Retrospective review of a prospectively collected multicenter registry of pediatric patients with cerebral palsy (CP) and neuromuscular scoliosis (NMS) undergoing spinal fusion.
Objective
To define risk factors for unplanned readmission after elective spinal deformity surgery.
Summary of background data
Patients with CP and NMS have high rates of hospital readmission; however, risk factors for readmission are not well established.
Methods
Univariate and multivariate analyses were used to compare the demographics, operative and postoperative course, radiographic characteristics, and preoperative Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaires of patients who did not require readmission to those who required either early readmission (within 90 days of the index surgery) or late readmission (readmission after 90 days).
Results
Of the 218 patients identified, 19 (8.7%) required early readmission, while 16 (7.3%) required late readmission. Baseline characteristics were similar between the three cohorts. On univariate analysis, early readmission was associated with longer duration of surgery (p < 0.001) and larger magnitude of residual deformity (p = 0.003 and p = 0.029 for postoperative major and minor angles, respectively). The health score of the CPCHILD Questionnaire was lower in patients who required early readmission than in those who did not require readmission (p = 0.032). On multivariate analysis, oral feeding status was inversely related to early readmission (less likely to require readmission), while decreasing lumbar lordosis and increasing length of surgery were related to an increased likelihood of early readmission.
Conclusions
In patients with CP and NMS, longer surgical time, larger residual major and minor Cobb angles, lumbar lordosis, feeding status, and overall health may be related to a greater likelihood for early hospital readmission after elective spinal fusion. No factors were identified that correlated with an increased need for late hospital readmission after elective spinal fusion in patients with CP.
Level of evidence
IV.
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Funding
This study was supported in part by grants to the Setting Scoliosis Straight Foundation in support of Harms Study Group research from DePuy Synthes Spine, EOS Imaging, K2M, Medtronic, NuVasive and Zimmer Biomet. Harms Study Group Investigators: Aaron Buckland, MD; New York University, Amer Samdani, MD; Shriners Hospitals for Children—Philadelphia, Amit Jain, MD; Johns Hopkins Hospital, Baron Lonner, MD; Mount Sinai Hospital, Benjamin Roye, MD; Columbia University, Burt Yaszay, MD; Rady Children’s Hospital, Chris Reilly, MD; BC Children’s Hospital, Daniel Hedequist, MD; Boston Children’s Hospital, Daniel Sucato, MD; Texas Scottish Rite Hospital, David Clements, MD; Cooper Bone & Joint Institute New Jersey, Firoz Miyanji, MD; BC Children’s Hospital, Harry Shufflebarger, MD; Nicklaus Children's Hospital, Jack Flynn, MD; Children’s Hospital of Philadelphia, Jahangir Asghar, MD; Cantor Spine Institute, Jean Marc Mac Thiong, MD; CHU Sainte-Justine, Joshua Pahys, MD; Shriners Hospitals for Children—Philadelphia, Juergen Harms, MD; Klinikum Karlsbad-Langensteinbach, Karlsbad, Keith Bachmann, MD; University of Virginia, Larry Lenke, MD; Columbia University, Mark Abel, MD; University of Virginia, Michael Glotzbecker, MD; Boston Children’s Hospital, Michael Kelly, MD; Washington University, Michael Vitale, MD; Columbia University, Michelle Marks, PT, MA; Setting Scoliosis Straight Foundation, Munish Gupta, MD; Washington University, Nicholas Fletcher, MD; Emory University, Patrick Cahill, MD; Children’s Hospital of Philadelphia, Paul Sponseller, MD; Johns Hopkins Hospital, Peter Gabos, MD: Nemours/Alfred I. duPont Hospital for Children, Peter Newton, MD; Rady Children’s Hospital, Peter Sturm, MD; Cincinnati Children’s Hospital, Randal Betz, MD; Institute for Spine & Scoliosis, Ron Lehman, MD; Columbia University, Stefan Parent, MD: CHU Sainte-Justine, Stephen George, MD; Nicklaus Children's Hospital, Steven Hwang, MD; Shriners Hospitals for Children—Philadelphia, Suken Shah, MD; Nemours/Alfred I. duPont Hospital for Children, Tom Errico, MD; Nicklaus Children's Hospital, Vidyadhar Upasani, MD; Rady Children’s Hospital.
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Institutional review board (IRB) approval for this study was obtained from each of the contributing centers prior to the study’s initiation.
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Vivas, A.C., Pahys, J.M., Jain, A. et al. Early and late hospital readmissions after spine deformity surgery in children with cerebral palsy. Spine Deform 8, 507–516 (2020). https://doi.org/10.1007/s43390-019-00007-1
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DOI: https://doi.org/10.1007/s43390-019-00007-1