Spitzer Allison B, Shaw K Aaron, Schmitz Michael, Devito Dennis P, Murphy Joshua S
Children's Healthcare of Atlanta, Scottish Rite Campus, 1001 Johnson Ferry Road NE, Atlanta, GA 30342-1605, USA.
Dwight D. Eisenhower Army Medical Center, 300 E Hospital Rd, Fort Gordon, Augusta, GA 30905, USA.
Spine Deform. 2019 Jan;7(1):158-162. doi: 10.1016/j.jspd.2018.05.002.
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.
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.
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 readmission (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.
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 III.
据报道，先天性心脏病（CHD）患儿心脏手术后发生脊柱侧弯的风险增加。以往的样本研究表明，这些患者可安全地接受后路脊柱融合术（PSF），并发症发生率较低。本研究的目的是利用全国性数据库，对一大群患有CHD的儿科患者后路脊柱融合术的围手术期并发症情况进行更新分析。
使用NSQIP-P数据库中的30天围手术期结果数据进行回顾性队列研究。我们的纳入标准是所有通过CPT编码接受后路脊柱融合术的儿科患者。患者被分为两组：有CHD心脏手术史的患者和没有CHD心脏手术史的患者。术后并发症根据Clavien-Dindo系统进行分类。在单因素和多因素逻辑回归分析中评估危险因素，显著性设定为p < 0.05。
我们的研究结果包括3426例儿科患者（68.2%为女性，31.8%为男性），脊柱融合术时的中位年龄为13.7±2.87岁。312例患者诊断为CHD，其中128例曾接受过心脏手术。总体并发症发生率为6.68%，既往心脏手术队列中的发生率为10.9%（p = 0.068）。最常见的总体围手术期并发症是计划外再次入院（3.5%）、再次手术（2.6%）和浅表伤口裂开（2.5%）。有心脏手术史的患者术后并发症风险并未增加；然而，输血（p < 0.001）、支气管肺发育不良（p < 0.001）、支气管肺发育不良合并既往心脏手术（p = 0.004）以及神经肌肉诊断（p < 0.001）均是该队列中术后主要并发症的危险因素。
接受过治疗CHD心脏手术的脊柱侧弯患儿在接受后路脊柱融合术30天内围手术期并发症风险并未增加。然而，接受过治疗CHD心脏手术且患有支气管肺发育不良或相关神经肌肉疾病的患者围手术期并发症风险增加。小儿骨科脊柱外科医生必须熟悉在治疗这些患者时可能面临的潜在围手术期障碍的最新情况，这在一个大型且具有代表性的队列中得到体现。
三级。
