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Do All Patients With Cerebral Palsy Require Postoperative Intensive Care Admission After Spinal Fusion?

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Abstract

Study Design

Retrospective review of a prospective cohort.

Objective

To identify patient and surgical factors that alter the length of postoperative intensive care unit (ICU) stays after spinal fusion/ instrumentation in patients with neuromuscular scoliosis secondary to cerebral palsy (CP).

Summary of Background Data

High perioperative complication rates in patients with CP contribute to the practice of utilizing the ICU postoperatively for monitoring. However, this is costly and little is known regarding which patients truly need this increased acuity of care.

Methods

A prospective, multicenter database was queried for patients with CP who underwent spinal fusion and instrumentation. Patients with an ICU length of stay (LOS) ⩽1 day were assumed to not have required postoperative ICU admission. Demographic and surgical characteristics were compared between those with ICU LOS of ⩽1 day versus > 1 day. A classification and regression tree (CART) analysis was utilized to create a decision algorithm for postoperative ICU admission.

Results

Three hundred twenty-four patients were identified with a mean ICU LOS of 4.7 days (range 0–47). Sixty-eight patients (21%) had an ICU LOS ⩽1 day and 256 patients (79%) had an ICU LOS >1 day. CART analysis demonstrated that the institution where the surgery was performed was the primary predictor with two groups: sites that almost routinely had ICU stay > 1 day (92%) and those that were split (50.5% > 1 day). In the latter group, an operative time greater than 4 hours was a risk factor for a longer ICU stay.

Conclusion

Because of their heterogeneous makeup, CP patients should be evaluated individually and their postoperative disposition should not be based on institutional tradition but instead on objective surgical factors. For those patients with surgical times less than 4 hours, discussions should be held regarding the safety of a postoperative disposition to a regular floor.

Level of Evidence

Level III.

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Author information

Authors and Affiliations

  1. Children’s of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA

    Jaysson T. Brooks MD

  2. Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA

    Burt Yaszay MD, Carrie E. Bartley MA, Tracey P. Bastrom MA & Peter O. Newton MD

  3. The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA

    Paul D. Sponseller MD

  4. Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  5. Shriners Hospitals for Children, 3551 N. Broad St., Philadelphia, PA, 19140, USA

    Amer Samdani MD

  6. Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, PA, 19104, USA

    Patrick J. Cahill MD

  7. British Columbia Children’s Hospital, 4480 Oak St, Vancouver, BC, Canada

    Firoz Miyanji MD

Authors
  1. Jaysson T. Brooks MD
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  2. Burt Yaszay MD
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  3. Carrie E. Bartley MA
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  4. Tracey P. Bastrom MA
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  5. Paul D. Sponseller MD
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  6. Suken A. Shah MD
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  7. Amer Samdani MD
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  8. Patrick J. Cahill MD
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  9. Firoz Miyanji MD
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  10. Peter O. Newton MD
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Consortia

Harms Study Group

Corresponding author

Correspondence to Burt Yaszay MD.

Additional information

This study was conducted at Rady Children’s Hospital, San Diego, CA.

Author disclosures: JTB (grants from OMeGA Medical Grants Association and Setting Scoliosis Straight Foundation, during the conduct of the study), BY (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from K2M and DePuy Synthes Spine; personal fees from NuVasive, Medtronic, Orthopediatrics, Stryker, and Globus; grants from Setting Scoliosis Straight Foundation, outside the submitted work; in addition, BY has a patent K2M with royalties paid), CEB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), TPB (grants from Setting Scoliosis Straight Foundation to her institution, during the conduct of the study), PDS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, personal fees from Globus, outside the submitted work), SAS (grants from Setting Scoliosis Straight Foundation from DePuy Synthes Spine and K2M in support of Harms Study Group research, during the conduct of the study; personal fees from DePuy Synthes Spine and K2M, outside the submitted work), AS (grants and other from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, Misonix, Stryker, and Zimmer Biomet; other from Scoliosis Research Society and Children’s Spine Study Group, outside the submitted work), PJC (personal fees from Biogen, Inc. and NuVasive, Inc., outside the submitted work; and board or committee member, AAOS; editorial or governing board, Journal of Bone and Joint Surgery—American and Spine Deformity; board or committee member, Pediatric Orthopaedic Society of North America; board or committee member, Scoliosis Research Society), FM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation; other from Rady Children’s Specialists; grants, personal fees, and nonfinancial support from DePuy Synthes Spine; grants and other from SRS; grants from EOS imaging; personal fees from Thieme Publishing; grants from NuVasive; other from Electrocore; personal fees from Cubist; other from International Pediatric Orthopedic Think Tank; grants, nonfinancial support, and other from Orthopediatrics; grants, personal fees, and nonfinancial support from K2M; grants and nonfinancial support from Alphatech, outside the submitted work; in addition, PON has a patent “Anchoring Systems and Methods for Correcting Spinal Deformities” [8540754] with royalties paid to DePuy Synthes Spine, a patent “Low Profile Spinal Tethering Systems” [8123749] licensed to DePuy Spine, Inc., a patent “Screw Placement Guide” [7981117] licensed to DePuy Spine, Inc., a patent “Compressor for Use in Minimally Invasive Surgery” [7189244] licensed to DePuy Spine, Inc., and a patent “Posterior Spinal Fixation” pending to K2M), Harms Study Group (grants from DePuy Synthes Spine and K2M, Inc., during the conduct of the study; grants from EOS Imaging, Zimmer Biomet, Medtronic Spine, Ellipse, SpineGuard, Globus, Stryker, NuVasive, Mazor Robotics, and OrthoPediatrics, outside the submitted work).

IRB approval was obtained for this study.

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Brooks, J.T., Yaszay, B., Bartley, C.E. et al. Do All Patients With Cerebral Palsy Require Postoperative Intensive Care Admission After Spinal Fusion?. Spine Deform 7, 112–117 (2019). https://doi.org/10.1016/j.jspd.2018.06.003

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  • DOI: https://doi.org/10.1016/j.jspd.2018.06.003

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