30-day Outcomes in Primary vs. Revision Posterior Spinal Fusion for Pediatric Spinal Deformity.

OBJECTIVES

Current evidence, with regard to primary vs. revision spinal fusions in pediatric spine deformities, is limited to inpatient outcomes only. The current study aims to analyze and compare 30-day outcomes in pediatric spine deformity patients undergoing a primary vs. a revision posterior spinal fusion.

PATIENTS AND METHODS

The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology (CPT) codes for patients undergoing posterior spinal fusions (22800, 22802 and 22804). Patients undergoing concurrent anterior fusion/combined fusion and anterior-only fusions were removed from the study. Revision spinal fusions were captured using CPT codes for re-insertion of spinal fixation device (22830), exploration of spinal fusions (22849), 22850 and 22852 (removal of posterior instrumentation).

RESULTS

Out of a total of 13,398 patients, 332 (2.5%) underwent a revision posterior spinal fusion and the remained underwent primary spinal fusion. Following adjustment for baseline clinical characteristics, patients undergoing revision posterior spinal fusions were at a higher risk of deep surgical site infections (OR 2.43 [95% CI 1.10-5.35]; p = 0.028), organ/space surgical site infections (OR 4.09 [1.19-14.04]; p = 0.025) and 30-day unplanned re-operations (OR 1.87 [95% CI 1.17-3.00].

CONCLUSIONS

Pediatric spine deformity patients undergoing revision spinal fusions are at a higher risk of experiencing wound-complications and subsequent unplanned re-operations within 30-days of surgery. Providers should promote careful wound-care and/or awareness among care-givers to minimize the risks and costs associated with these specific adverse outcomes.