Abstract
Objective
The objective of this study is to identify preoperative laboratory values and patient factors that are associated with postoperative respiratory complications in pediatric neuromuscular scoliosis (NMS) populations undergoing posterior spinal fusion (PSF) with instrumentation.
Summary of Background Data
PSF in NMS patients are high-risk surgeries. Respiratory complications are the most common post-operative event, with rates up to 28.2% following surgery.
Methods
A single-surgeon, two-hospital pediatric spine surgery database was reviewed to identify all patients who underwent PSF for NMS. Diagnoses included cerebral palsy (n=83), myelomeningocele (n = 13), spinal muscular atrophy (n=4), and other (n = 11). This study defined respiratory complications as postoperative pneumonia, pleural effusion, pneumothorax, need for reintubation, respiratory status requiring a return to the pediatric intensive care unit (PICU), or prolonged (> 4-day) need for mechanical ventilation. Preoperative laboratory values for transferrin, prealbumin, hemoglobin/hematocrit, total protein, albumin, and total lymphocyte count were collected.
Results
There were 50 males and 61 females with a mean age of 14 years 2.5 months (8–20 years). Seventeen patients (15.3%) experienced postoperative respiratory complications. On univariate analysis, any history of pneumonia, the presence of gastrostomy tube, and low transferrin levels were associated with postoperative respiratory complications, and a strong trend (p = .06) was observed for tracheostomy. On multivariate analysis, the presence of gastrostomy tube and history of pneumonia remained as clinically significant predictors of postoperative respiratory complications.
Conclusion
Pediatric NMS patients undergoing PSF that have history of pneumonia or gastrostomy tube present at time of surgery are at increased risk for postoperative respiratory complications. The univariate associations of tracheostomy presence and low transferrin levels with postoperative respiratory complications deserve further examination.
Level of Evidence
Level II.
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Author disclosures: SJL (none), RF (none).
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
IRB approval statement. This study was approved by the Washington University School of Medicine Institutional Review Board (#201606053).
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Luhmann, S.J., Furdock, R. Preoperative Variables Associated With Respiratory Complications After Pediatric Neuromuscular Spine Deformity Surgery. Spine Deform 7, 107–111 (2019). https://doi.org/10.1016/j.jspd.2018.05.005
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DOI: https://doi.org/10.1016/j.jspd.2018.05.005