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Surgical Risk Stratification Based on Preoperative Risk Factors in Severe Pediatric Spinal Deformity Surgery

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Abstract

Study design

Retrospective review.

Objective

The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a preoperative classification that stratifies surgical risk and case difficulty.

Summary of Background Data

Pediatric spinal deformity (PSD) surgery can be challenging technically as well as economically. Often, a multidisciplinary approach to managing these patients is necessary. In an environment where resources are limited, such as in global outreach efforts, a method for stratifying PSD surgical cases can be useful for allocating appropriate resources and assigning appropriate skill sets in order to optimize patient outcomes and to streamline efforts.

Materials and Methods

A total of 145 consecutive PSD patients who underwent instrumented spinal fusion were reviewed. Radiographic measurements and demographic data were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the preoperative neurologic status, body mass index and type of osteotomies. Multiple regression analysis (MRA) and logistic regression analysis (LRA) were applied to indicate risk factors for complications.

Results

The average age was 14.3 years (10—20 years). The etiology was idiopathic scoliosis (n = 71), congenital scoliosis (n = 38), infectious (n = 11), and others. 23 patients had neurologic deficits preoperatively. Twenty-three patients had a posterior vertebral column resection. Patients were classified as Level 1 (n = 5), Level 2 (n = 19), Level 3 (n = 24), Level 4 (n = 58), and Level 5 (n = 39). Intraoperative neuro-monitoring changes were observed in 46 cases. Major complications were seen in 45 cases. A major complication consisted of implant related (n = 13), deep wound infection (n = 8), neurologic deficit (n = 7), death (n = 2), and others (n = 9). MRA demonstrated a significant correlation between classified level and %EBL/TBV, operative time, and complication rate. The risk level predicted the occurrence of general (odds ratio [OR] = 1.54; 95% confidence interval [CI] = 1.08—2.21; p =.019) and neurologic (OR = 3.34; 95% CI = 1.06—17.70; p =.036) complications. Osteotomy and resection procedures were independent predictors for postoperative neurologic complications (OR = 1.7, 95% CI = 1.11-2.85; p =.015).

Conclusion

Corrective spine surgery for complex pediatric deformity is challenging and carries a substantial risk. No single parameter appears to independently predict postoperative complications. However, when all risk factors are considered, there is a trend toward increased intraoperative electromonitoring change and postoperative neurologic risk with the higher level score in our classification. The newly established surgical risk stratification based on patient-specific clinical and radiographic factors can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal outcomes.

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References

  1. 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;8:904–10.

    Article  Google Scholar 

  2. Diab M, Smith AR, Kuklo TR. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spinal Deformity Study Group. Spine 2007;32:2759–63.

    Article  Google Scholar 

  3. Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 2007;89:2427–32.

    Article  Google Scholar 

  4. Mohamad F, Parent S, Pawelek J, et al. Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop 2007;27:392–7.

    Article  Google Scholar 

  5. Guigui P, Blamoutier A. Complications of surgical treatment of spinal deformities: a prospective multicentric study of 3311 patients [in French]. Groupe d’Etude de la Scoliose. Rev Chir Orthop Repara-trice Appar Mot 2005;91:314–27.

    Article  CAS  Google Scholar 

  6. Lipton GE, Miller F, Dabney KW, et al. Factors predicting postoperative complications following spinal fusions in children with cerebral palsy. J Spinal Disord 1999;12:197–205.

    CAS  PubMed  Google Scholar 

  7. Bachy M, Bouyer B, Vialle R. Infections after spinal correction and fusion for spinal deformities in childhood and adolescence. Int Orthop 2012;36:465–9.

    Article  Google Scholar 

  8. Weiss HR, Goodall D. Rate of complications in scoliosis surgery—a systematic review of the Pub Med literature. Scoliosis 2008;3:9.

    Article  Google Scholar 

  9. Pahys JM, Guille JT, D’Andrea LP, et al. Neurologic injury in the surgical treatment of idiopathic scoliosis: guidelines for assessment and management. J Am Acad Orthop Surg 2009;17:426–34.

    Article  Google Scholar 

  10. Modi HN, Suh SW, Hong JY, Yang JH. Posterior multilevel vertebral osteotomy for severe and rigid idiopathic and nonidiopathic kyphoscoliosis: a further experience with minimum two-year follow-up. Spine 2011;36:1146–53.

    Article  Google Scholar 

  11. Phillips JH, Knapp Jr DR, Herrera-Soto J. Mortality and morbidity in early onset scoliosis surgery. Spine 2013;38:324–7.

    Article  Google Scholar 

  12. Smith JS, Fu KM, Polly Jr DW, et al. Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine 2010;35:2140–9.

    Article  Google Scholar 

  13. Saklad M. Grading of patients for surgical procedures. Anesthesiol 1941;2:281–4.

    Article  Google Scholar 

  14. Williams BJ, Sansur CA, Smith JS, et al. Incidence of unintended durotomy in spine surgery based on 108,478 cases. Neurosurgery 2011;68:117–23.

    Article  Google Scholar 

  15. Sponseller PD, Shah SA, Abel MF, et al. Infection rate after spine surgery in cerebral palsy is high and impairs results: multicenter analysis of risk factors and treatment. Clin Orthop Relat Res 2010;468:711–6.

    Article  Google Scholar 

  16. Pull ter Gunne AF, Hosman AJ, Cohen DB, et al. A methodological systematic review on surgical site infections following spinal surgery: part 1: risk factors. Spine 2012;37:2017–33.

    Article  Google Scholar 

  17. Fu KM, Smith JS, Polly DW, et al. Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database. Scoliosis Research Society Morbidity and Mortality Committee. J Neurosurg Pediatr 2011;7:37–41.

    Article  Google Scholar 

  18. Master DL, Son-Hing JP, Poe-Kochert C, et al. Risk factors for major complications after surgery for neuromuscular scoliosis. Spine 2011;36:564–71.

    Article  Google Scholar 

  19. Reames DL, Smith JS, Fu KM, et al. Scoliosis Research Society Morbidity and Mortality Committee. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine 2011;36:1484–91.

    Article  Google Scholar 

  20. Lenke LG, Newton PO, Sucato DJ, et al. Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine 2013;38:119–32.

    Article  Google Scholar 

  21. Sharma S, Wu C, Andersen T, et al. Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 2013;22:1230–49.

    Article  Google Scholar 

  22. Buchowski JM, Bridwell KH, Lenke LG, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine 2007;32:2245–52.

    Article  Google Scholar 

  23. Aleissa S, Parsons D, Grant J, et al. Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors. Can J Surg 2011;54:263–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Adult and Pediatric Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Oheneba Boachie-Adjei MD, Matthew E. Cunningham MD, PhD & Han Jo Kim MD

  2. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Mitsuru Yagi MD, PhD

  3. Department of Orthopedic Surgery, Hospital Ruber International, Calle de la Masó, 38, 28034, Madrid, Spain

    Cristina Sacramento-Dominguez MD, PhD

  4. Department of Neurosurgery, Korle Bu Teaching Hospital, P.O. Box KB77, Korle Bu, Accra, Ghana

    Harry Akoto MD

  5. Department of Orthopaedic Surgery, University of California, Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA, 95817-2282, USA

    Munish Gupta MD

  6. Department of Orthopaedics, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA

    William F. Hess MD

  7. Department of Orthopedic Surgery, New York University-Hospital for Joint Diseases, 301 East 17th Street, 1402, New York, NY, 10003, USA

    Baron S. Lonner MD

  8. 2 Orthopaedic Clinic, University of Athens, Greece

    Elias Papadopoulus MD

  9. Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, P° de la Castellana, 261 28046, Madrid, Spain

    Federico Sanchez-Perez-Grueso MD

  10. Spine Unit, Servicio de COT, Hospital Vall d’Hebron, Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain

    Feran Pelise MD

  11. Norwich Orthopedic Group, 82 New Park Ave, North Franklin, Norwich, CT, 06254, USA

    Kenneth J. Paonessa MD

  12. Research Department, FOCOS Hospital, P.O. Box KD 779, Kanda, No. 8 Teshie Street, Accra, Ghana

    Jennifer Ayamga BS, MPA

Authors
  1. Oheneba Boachie-Adjei MD
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  2. Mitsuru Yagi MD, PhD
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  3. Cristina Sacramento-Dominguez MD, PhD
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  4. Harry Akoto MD
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  5. Matthew E. Cunningham MD, PhD
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  6. Munish Gupta MD
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  7. William F. Hess MD
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  8. Baron S. Lonner MD
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  9. Jennifer Ayamga BS, MPA
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  10. Elias Papadopoulus MD
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  11. Federico Sanchez-Perez-Grueso MD
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  12. Feran Pelise MD
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  13. Kenneth J. Paonessa MD
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  14. Han Jo Kim MD
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Consortia

FOCOS Spine Research Group

Corresponding author

Correspondence to Oheneba Boachie-Adjei MD.

Additional information

Author disclosures: OBA (grants, personal fees, nonfinancial support, and other from K2M; nonfinancial support and other from DePuy Spine; grants from Medtronic; grants, personal fees and other from Baxano (Trans 1), outside the submitted work; a patent K2M with royalties paid and serves on the board of scientific advisors for K2M); MY (nonfinancial support from K2M Inc, grants from Surgical Spine Inc, other from Depuy Synthes Inc, outside the submitted work); CSD (none); HJK (none); HA (none); MEC (none); MG (none); WFH (K2M, outside the submitted work); BSL (grants from Setting Scoliosis Straight Foundation, grants from AO Spine, grants from John and Marcella Fox Fund, grants from OREF, personal fees and other from DePuy Spine, personal fees from K2M, other from Spine Search, other from Paradigm Spine, outside the submitted work); JA(none); EP (none); FSPG (none); FP (none); KJP (Complex Spine Study Group, outside the submitted work).

This study was approved by the Institutional Review Board of the hospital.

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Boachie-Adjei, O., Yagi, M., Sacramento-Dominguez, C. et al. Surgical Risk Stratification Based on Preoperative Risk Factors in Severe Pediatric Spinal Deformity Surgery. Spine Deform 2, 340–349 (2014). https://doi.org/10.1016/j.jspd.2014.05.004

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  • DOI: https://doi.org/10.1016/j.jspd.2014.05.004

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