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The Incidence and Risk Factors for Short-term Morbidity and Mortality in Pediatric Deformity Spinal Surgery: An Analysis of the NSQIP Pediatric Database

Pugely, Andrew J. MD; Martin, Christopher T. MD; Gao, Yubo PhD; Ilgenfritz, Ryan MD; Weinstein, Stuart L. MD

doi: 10.1097/BRS.0000000000000365
Health Services Research

Study Design. Retrospective review of a prospective cohort.

Objective. To determine the incidence and risk factors for 30-day morbidity and mortality after pediatric deformity spinal surgery.

Summary of Background Data. Pediatric deformity spinal surgery is generally considered a safe and effective treatment option. The rising costs associated with spinal surgery and related perioperative complications have received national attention. Few studies with standardized definitions and data collection methods exist.

Methods. A large, multicenter clinical registry specifically designed to collect pediatric surgical outcomes was queried for all patients undergoing spinal deformity surgery in 2012. Current Procedural Terminology codes were used to select patients undergoing anterior, posterior, and combined fusions. Detailed patient and case characteristics were analyzed. Thirty-day morbidity and mortality rates were calculated. Univariate and multivariate logistic regression analyses were used to identify patient characteristics, comorbidities, and operative variables predictive of complication.

Results. In total, 2005 pediatric patients undergoing deformity spinal fusion were included. The rate of 30-day complications was 10.0%; with a mortality rate of 0.15% (3 patients), a morbidity rate of 8.4%, reoperation rate of 3.74%, and readmission rate of 3.94%. The morbidity rate was highest in the neuromuscular group (13.09%) and lowest in the idiopathic cohort (5.69%), P < 0.01). Compared with posterior fusions, anterior fusions and those extending to the pelvis were associated with higher complication rates (P < 0.01). Risk factors for complication included hepatobiliary disease (P = 0.03), cognitive impairment (P = 0.02), elevated American Society of Anesthesiologists class (P < 0.01), and prolonged operative time (P < 0.01).

Conclusion. The overall rate of 30-day morbidity after pediatric spinal deformity surgery was 10%. Multiple patient comorbidities and surgical duration and invasiveness were associated with an increased complication risk. These data may aid in the informed consent process, facilitate patient risk assessment, and allow quality comparisons between surgeons and institutions.

Level of Evidence: 2

Supplemental Digital Content is Available in the Text.In a prospective quality improvement registry, the rate of 30-day complications after pediatric spinal deformity surgery was 10.0%, mortality rate was 0.15%, morbidity rate was 8.4%, 30-day reoperation rate was 3.74%, and unplanned readmission rate was 3.94%. These data may serve as baseline rates from which to compare institutions, provide risk assessment, and personalize informed consent.

From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.

Address correspondence and reprint requests to Andrew J. Pugely, MD, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242; E-mail:

Acknowledgment date: February 4, 2014. Revision date: March 24, 2014. Acceptance date: March 24, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants.

© 2014 by Lippincott Williams & Wilkins