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Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien–Dindo–Sink system

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Abstract

Purpose

Published complication rates after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) range from 1 to 22%. Complications are often minor and may be underestimated in registries. This study describes complications of PSF for AIS, classifies them according to a Clavien–Dindo–Sink (CDS) system, and investigates risk factors for occurrence of a complication.

Methods

This retrospective cohort study at two academic centers included all AIS patients aged 10–18 who underwent primary PSF 4/2014–12/2019. Data included demographics, comorbidities, curve magnitude, Lenke classification, levels osteotomized/fused, implant density, 90-day emergency department visits, readmissions, reoperations, and complications as defined by Harms Study Group.

Results

Among 424 patients, mean age was 14.7, mean BMI 22, 77% were female, and 57% had no comorbidities. There were 270 complications (0.64 per patient); 198 patients (47%) had ≥ 1 complication; and 63 patients (15%) had CDS grade ≥ II complications (deviation from standard postoperative course). Complications not related to persistent pain occurred in 103 patients (24%). Ninety-three percent of complications did not require readmission or reoperation (CDS I–II). Within 90 days, 8% presented to an ED, 2% required readmission, and 2% required reoperation. Common complications were back pain > 6 weeks postoperatively (26%), surgical site complications (7%), and ileus/prolonged constipation (3%). Risk factors for experiencing any complication were BMI ≥ 34 (OR 3.44) and Lenke 6 curve (OR 1.95).

Conclusion

One in four AIS patients experiences a complication not related to persistent pain after primary PSF, higher than rates published from self-reported registries. Obesity and Lenke 6 curve may increase risk. While most do not require readmission or surgery, 15% of patients have their postoperative course altered by complications.

Level of evidence

III—retrospective cohort study.

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Availability of data and materials

Data collected in this study are available upon reasonable request.

Code availability

Statistical code collected in this study are available upon reasonable request.

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Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, University of North Carolina, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC, 27599-7055, USA

    Lukas G. Keil, Alysa B. Nash & Joseph D. Stone

  2. School of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Stephen M. Himmelberg

  3. School of Medicine, Emory University, Atlanta, GA, USA

    Ndéye F. Guissé

  4. Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA

    Nicholas D. Fletcher

Authors
  1. Lukas G. Keil
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  2. Stephen M. Himmelberg
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  3. Ndéye F. Guissé
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  4. Alysa B. Nash
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  5. Nicholas D. Fletcher
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  6. Joseph D. Stone
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Contributions

LGK, SMH and NFG study design, data collection, manuscript drafting and revisions, final manuscript approval, accountable for all aspects of work. ABN data collection, manuscript drafting and revisions, final manuscript approval, accountable for all aspects of work. NDF and JDS study design, manuscript drafting and revisions, final manuscript approval, accountable for all aspects of work. Each of the listed authors meets each of the authorship requirements as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (icmje.org).

Corresponding author

Correspondence to Lukas G. Keil.

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Conflict of interest

All authors have no potential conflicts of interest to disclose.

Ethics approval

The local institutional review board approved this study.

Consent to participate

The local IRBs granted a waiver of informed consent for this study based on minimal risk.

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Should this study be accepted for publication, the authors grant consent for publication solely to Spine Deformity.

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Keil, L.G., Himmelberg, S.M., Guissé, N.F. et al. Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien–Dindo–Sink system. Spine Deform 10, 607–614 (2022). https://doi.org/10.1007/s43390-021-00468-3

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