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Perioperative Complications After Spinal Fusion in Pediatric Patients With Congenital Heart Disease

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Abstract

Background

Children with congenital heart disease (CHD) have been reported to be at increased risk of developing scoliosis following cardiac surgery. Previous sample studies have reported that these patients may safely undergo posterior spinal fusion (PSF) with low complication rates. The goal of this study is to provide an updated analysis of the perioperative complication profile for posterior spinal fusion in a large cohort of pediatric patients with CHD, using a nationwide database.

Methods

A retrospective cohort study was conducted using 30-day perioperative outcomes data from the NSQIP-P database. Our inclusion criteria were all pediatric patients who underwent posterior spinal fusion by CPT code. Patients were subdivided into two groups: those with a history of cardiac surgery for CHD and those without. Postoperative complications were classified according to the Clavien-Dindo system. Risk factors were assessed in univariate and multivariate logistic regression analyses, with significance set at p < .05.

Results

Our results included 3,426 pediatric patients (68.2% female, 31.8% male) with a median age at spinal fusion of 13.7 ± 2.87 years. A CHD diagnosis was present in 312 patients, with 128 having had prior cardiac surgery. The overall complication rate was 6.68%, with a 10.9% rate in the prior cardiac surgery cohort (p = .068). The most common overall perioperative complications were unplanned read-mission (3.5%), reoperation (2.6%), and superficial wound dehiscence (2.5%). Patients with a history of cardiac surgery were not at increased risk for postoperative complications; however, blood transfusion (p < .001), bronchopulmonary dysplasia (p < .001), combined bronchopulmonary dysplasia and previous cardiac surgery (p = .004), and a neuromuscular diagnosis (p < .001) were all risk factors for major postoperative complications in this cohort.

Conclusions

Children with scoliosis who have undergone cardiac surgery to address CHD are not at an increased risk of perioperative complications within 30 days of undergoing a posterior spinal fusion. However, patients who underwent cardiac surgery for CHD who also had bronchopulmonary dysplasia or an associated neuromuscular diagnosis are at increased risk for perioperative complications. It is important for pediatric orthopedic spine surgeons to be familiar with an updated profile of potential perioperative obstacles they may face when treating these patients, as seen in a large and representative cohort.

Level of Evidence

Level III.

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References

  1. Taggart NW, Shaughnessy WJ, Stans AA, et al. Outcomes of spinal fusion in children with congenital heart disease. J Pediatr Orthop 2010;30:670–5.

    Article  Google Scholar 

  2. Luke MJ, McDonnell EJ. Congenital heart disease and scoliosis. J Pediatr 1968;73:725–33.

    Article  CAS  Google Scholar 

  3. Herrera-Soto JA, Vander Have KL, Barry-Lane P, Woo A. Spinal deformity after combined thoracotomy and sternotomy for congenital heart disease. J Pediatr 2006;26:211–5.

    Google Scholar 

  4. American College of Surgeons. About ACS NSQIP Pediatric, https://www.facs.org/quality-programs/childrens-surgery/pediatric/overview. Accessed August 8, 2017.

  5. Mourani PM, Abman SH. Pulmonary vascular disease in bronchopulmonary dysplasia: pulmonary hypertension and beyond. Curr Opin Pediatr 2013;25:329–37.

    Article  CAS  Google Scholar 

  6. Kim GB. Pulmonary hypertension in infants with bronchopulmonary dysplasia. Korean J Pediatr 2010;53:688–93.

    Article  Google Scholar 

  7. Sink EL, Leunig M, Zaltz I, et al. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 2012;470:2220–6.

    Article  Google Scholar 

  8. Kapoor M, Laham SG, Sawyer JR. Children at risk identified in an urban scoliosis school screening program: a new model. J Pediatr Orthop 2008;17:281–7.

    Article  Google Scholar 

  9. Kawakami N, Mimatsu K, Deguchi M, et al. Scoliosis and congenital heart disease. Spine 1995;20:1252–5; discussion 1256.

    Article  CAS  Google Scholar 

  10. Farley FA, Phillips WA, Herzenberg JE, et al. Natural history of scoliosis in congenital heart disease. J Pediatr Orthop 1991;11:42–7.

    Article  CAS  Google Scholar 

  11. Warner MA, Lunn RJ, O’Leary PW, et al. Outcomes of noncardiac surgical procedures in children and adults with congenital heart disease. Mayo Perioperative Outcomes Group. Mayo Clin Proc 1998;73: 728–34.

    Article  CAS  Google Scholar 

  12. Perez-Caballero C, Sobrino E, Vazquez JL, et al. Complication of surgery for scoliosis in children with surgically corrected congenital cardiac malformations. Cardiol Young 2009;19:272–7.

    Article  Google Scholar 

  13. Bartley CE, Yaszay B, Bastrom TP, et al. Perioperative and delayed major complications following surgical treatment of adolescent idiopathic scoliosis. J Bone Joint Am 2017;99:1206–12.

    Article  Google Scholar 

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Authors and Affiliations

  1. Children’s Healthcare of Atlanta, Scottish Rite Campus, 1001 Johnson Ferry Road NE, Atlanta, GA, 30342-1605, USA

    Allison B. Spitzer MD, Michael Schmitz MD, Dennis P. Devito MD & Joshua S. Murphy MD

  2. Dwight D. Eisenhower Army Medical Center, 300 E Hospital Rd, Fort Gordon, Augusta, GA, 30905, USA

    K. Aaron Shaw DO

Authors
  1. Allison B. Spitzer MD
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  2. K. Aaron Shaw DO
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  3. Michael Schmitz MD
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  4. Dennis P. Devito MD
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  5. Joshua S. Murphy MD
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Corresponding author

Correspondence to Joshua S. Murphy MD.

Additional information

IRB approval: This study was reviewed and approved by the Human Research Protection Office, Dwight D. Eisenhower Army Medical Center.

Author disclosures: ABS (none), KAS (none), MS (a consultant for Stryker instrument navigation and design), DPD (other from Medicrea Spine, nonfinancial support and other from K2M Spine, other from SeaSpine, other from SpineCraft, nonfinancial support and other from Mazor Robotics, other from Astura Spine, outside the submitted work), JSM (a consultant for DePuy Spine).

No funding was received for this study.

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Spitzer, A.B., Shaw, K.A., Schmitz, M. et al. Perioperative Complications After Spinal Fusion in Pediatric Patients With Congenital Heart Disease. Spine Deform 7, 158–162 (2019). https://doi.org/10.1016/j.jspd.2018.05.002

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  • DOI: https://doi.org/10.1016/j.jspd.2018.05.002

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