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Risk factors for postoperative pulmonary complications in the treatment of non-degenerative scoliosis by posterior instrumentation and fusion

  • Yunsheng Wang
  • Yong HaiEmail author
  • Yuzeng Liu
  • Li Guan
  • Tie Liu
Original Article

Abstract

Purpose

The aim of this study was to evaluate the prevalence and risk factors for postoperative pulmonary complications (PPC) after posterior instrumentation and fusion (PIF) in patients with non-degenerative scoliosis.

Methods

We retrospectively evaluated 703 patients (224 males, 479 females) diagnosed with non-degenerative scoliosis who underwent PIF in our center from January 2010 to January 2018. Preoperative, perioperative, demographic data, surgical methods and radiographic parameters were extracted and analyzed to identify risk factors for PPC.

Results

The mean age of the patients was 20.8 ± 9.0 years with the following diagnoses: congenital scoliosis (287/703, 40.8%), idiopathic scoliosis (281/703, 40.0%), neuromuscular scoliosis (103/703, 14.7%) and syndromic scoliosis (32/703, 4.5%). PPC manifested in 82 patients (11.7%) including pleural effusion (39/82, 47.6%), pneumonia (33/82, 40.2%), pneumothorax (3/82, 3.7%), respiratory failure (3/82, 3.7%), hemothorax (2/82, 2.4%), pulmonary edema (1/82, 1.2%) and pulmonary embolism (1/82, 1.2%). Multifactorial regression analysis confirmed that revision surgery [odds ratio (OR) = 2.320, P = 0.030], preoperative respiratory disease (OR = 14.286, P < 0.001), preoperative Cobb angle of main curve > 75° (OR = 1.701, P = 0.046) and thoracoplasty (OR = 4.098 P < 0.001) were risk factors for PPC after PIF in patients with non-degenerative scoliosis.

Conclusions

A prevalence of 11.7% PPC was observed after PIF. Risk factors were preoperative Cobb angle of main curve > 75°, preoperative respiratory disease, revision surgery and thoracoplasty. Surgeons should recognize and pay attention to these risk factors and take appropriate preventive measures to prevent severe pulmonary complications.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Scoliosis Pulmonary complications Spine Fusion 

Notes

Acknowledgements

The authors gratefully acknowledge the support from Beijing Chaoyang Hospital affiliated to China Capital Medical University. The author also thanks Dr. Yong Hai who supervised the study, provided technique support and corrected some mistakes.

Funding

This study has not received any fund support.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

586_2019_5968_MOESM1_ESM.pptx (133 kb)
Supplementary material 1 (PPTX 132 kb)

References

  1. 1.
    Liang J, Qiu G, Shen J et al (2010) Predictive factors of postoperative pulmonary complications in scoliotic patients with moderate or severe pulmonary dysfunction. J Spinal Disord Tech 23(6):388–392CrossRefGoogle Scholar
  2. 2.
    Greggi T, Bakaloudis G, Fusaro I et al (2010) Pulmonary function after thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 23(8):e63–e69CrossRefGoogle Scholar
  3. 3.
    Reames DL, Smith JS, Fu KM et al (2011) 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) 36(18):1484–1491CrossRefGoogle Scholar
  4. 4.
    Fu KM, Smith JS, Polly DW et al (2011) Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database. J Neurosurg Pediatr 7(1):37–41CrossRefGoogle Scholar
  5. 5.
    Sansur CA, Smith JS, Coe JD et al (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36(9):E593–E597CrossRefGoogle Scholar
  6. 6.
    Seo HJ, Kim HJ, Ro YJ, Yang HS (2013) Non-neurologic complications following surgery for scoliosis. Korean J Anesthesiol 64(1):40–46CrossRefGoogle Scholar
  7. 7.
    Lao L, Weng X, Qiu G, Shen J (2013) The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. J Orthop Surg Res 8:32CrossRefGoogle Scholar
  8. 8.
    De la Garza Ramos R, Goodwin CR, Abu-Bonsrah N et al (2016) 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 25(6):730–736Google Scholar
  9. 9.
    Taniguchi Y, Oichi T, Ohya J et al (2018) In-hospital mortality and morbidity of pediatric scoliosis surgery in Japan: analysis using a national inpatient database. Medicine (Baltimore).  https://doi.org/10.1097/MD.0000000000010277 Google Scholar
  10. 10.
    Levy BJ, Schulz JF, Fornari ED, Wollowick AL (2015) Complications associated with surgical repair of syndromic scoliosis. Scoliosis 10:14CrossRefGoogle Scholar
  11. 11.
    Bendon AA, George KA, Patel D (2016) Perioperative complications and outcomes in children with cerebral palsy undergoing scoliosis surgery. Paediatr Anaesth 26(10):970–975CrossRefGoogle Scholar
  12. 12.
    Kang GR, Suh SW, Lee IO (2011) Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosis. J Orthop Sci 16(2):139–147CrossRefGoogle Scholar
  13. 13.
    Vedantam R, Lenke LG, Bridwell KH et al (2000) A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for spinal arthrodesis. Spine (Phila Pa 1976) 25(1):82–90CrossRefGoogle Scholar
  14. 14.
    Yaszay B, Jazayeri R, Lonner B (2009) The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis. J Spinal Disord Tech 22(4):278–283CrossRefGoogle Scholar
  15. 15.
    Bjure J, Grimby G, Kasalický J et al (1970) Respiratory impairment and airway closure in patients with untreated idiopathic scoliosis. Thorax 25(4):451–456CrossRefGoogle Scholar
  16. 16.
    Xue X, Shen J, Zhang J et al (2015) An analysis of thoracic cage deformities and pulmonary function tests in congenital scoliosis. Eur Spine J 24(7):1415–1421CrossRefGoogle Scholar
  17. 17.
    Fu J, Liu C, Zhang YG et al (2015) Three-dimensional computed tomography for assessing lung morphology in adolescent idiopathic scoliosis following posterior spinal fusion surgery. Orthop Surg 7(1):43–49CrossRefGoogle Scholar
  18. 18.
    Shi Z, Wu Y, Huang J et al (2013) Pulmonary function after thoracoplasty and posterior correction for thoracic scoliosis patients. Int J Surg 11(9):1007–1009CrossRefGoogle Scholar
  19. 19.
    Gitelman Y, Lenke LG, Bridwell KH et al (2011) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976) 36(20):1665–1672CrossRefGoogle Scholar
  20. 20.
    Toll BJ, Samdani AF, Janjua MB et al (2018) Perioperative complications and risk factors in neuromuscular scoliosis surgery. J Neurosurg Pediatr 22(2):207–213CrossRefGoogle Scholar
  21. 21.
    Han K, Wang Y, Cui S, Xu C, Su P (2018) Successful surgery for a neuromuscular scoliosis patient by pulmonary rehabilitation with forced vital capacity below 30. Eur Spine J 27(9):2072–2075CrossRefGoogle Scholar
  22. 22.
    Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976) 35(11):465–470CrossRefGoogle Scholar
  23. 23.
    Liang W, Yu B, Wang Y et al (2016) Pleural effusion in spinal deformity correction surgery—a report of 28 cases in a single center. PLoS ONE.  https://doi.org/10.1371/journal.pone.0154964 Google Scholar
  24. 24.
    Jain A, Marks MC, Kelly MP et al (2018) Cost-utility analysis of operative vs. nonoperative treatment of thoracic AIS. Spine.  https://doi.org/10.1097/BRS.0000000000002936 (Epub ahead of print) Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Beijing Chao-Yang HospitalCapital Medical UniversityBeijingChina

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