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Who Needs a Pediatric Intensive Care Unit After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?

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Abstract

Background

Hypotensive events (HEs) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can lead to delayed neurologic postoperative deficits (DNPD). This study aimed to determine the incidence of HEs (mean arterial pressure [MAP] < 60 mmHg) after PSF for AIS and identify predictors for HEs.

Methods

Medical records of 99 consecutive patients who had PSF for AIS were retrospectively reviewed (2011–2013). Perioperative data were collected. Patients were divided into two groups based on MAP readings by an arterial line in the pediatric intensive care unit immediately postoperatively into postoperative day one: Group 1 (MAP ≥60 mmHg) and Group 2 (multiple occurrences of MAPs < 60 mmHg).

Mean values were compared using the independent t test. Multiple logistic regression was used to estimate the association of preoperative and intraoperative parameters with multiple HEs.

Results

Group 1 had 68 patients (68.7%) and Group 2 had 31 patients (31.3%). None of the compared parameters were associated significantly with multiple HE. However, patients who did not exhibit HEs within the first four hours postoperatively remained stable throughout the rest of the postoperative period. Only those with HEs in the first four hours experienced subsequent HEs in the first 24 hours. There were no DNPD or other major complications.

Conclusion

Results showed that the incidence of HEs after PSF in AIS can be as high as 31.3%. We did not find any significant risk factors. Although DNPD after PSF is a rare complication and we had none in this series, we suggest that these patients with multiple HEs may be at risk for DNPD as a result of hypotension and potential for cord ischemia. Therefore, all patients after PSF should be monitored in a pediatric intensive care unit—type environment or postanesthesia recovery room initially. If stable for, at least, the initial four hours, then patients should be good candidates for a less intensive environment.

Level of Evidence

Level 3.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ochsner Hospital for Children, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA

    Lawrence L. Haber MD

  2. Department of Orthopaedic Surgery, University of Mississippi Center, 2500 N State St, Jackson, MS, 39216, USA

    Erika D. Womack PhD & Michael Wade Shrader MD

  3. Department of Anesthesiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA

    Madhankumar Sathyamoorthy MBBS, MS

  4. Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS, 39202, USA

    James A. Moss MD

Authors
  1. Lawrence L. Haber MD
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  2. Erika D. Womack PhD
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  3. Madhankumar Sathyamoorthy MBBS, MS
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  4. James A. Moss MD
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  5. Michael Wade Shrader MD
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Corresponding author

Correspondence to Lawrence L. Haber MD.

Additional information

LLH (personal fees from Orthopediatrics, outside the submitted work); EDW (none); MS (none); JAM (none); MWS (paid consultant for Orthopediatrics and DePuy Spine).

The authors thank Patrick B. Wright, MD, University of Mississippi Medical Center, for contributing a portion of the patients for the study, and Alan Penman, PHD, MPH, University of Mississippi Medical Center, for his contributions toward statistical design and analysis.

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Haber, L.L., Womack, E.D., Sathyamoorthy, M. et al. Who Needs a Pediatric Intensive Care Unit After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis?. Spine Deform 6, 137–140 (2018). https://doi.org/10.1016/j.jspd.2017.08.006

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  • DOI: https://doi.org/10.1016/j.jspd.2017.08.006

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