Vivas Andrew C, Pahys Joshua M, Jain Amit, Samdani Amer F, Bastrom Tracey P, Sponseller Paul D, Newton Peter O, Hwang Steven W
Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA.
Department of Neurosurgery, University of South Florida, Tampa, FL, 33620, USA.
Spine Deform. 2020 Jun;8(3):507-516. doi: 10.1007/s43390-019-00007-1. Epub 2020 Mar 4.
Retrospective review of a prospectively collected multicenter registry of pediatric patients with cerebral palsy (CP) and neuromuscular scoliosis (NMS) undergoing spinal fusion.
To define risk factors for unplanned readmission after elective spinal deformity surgery. Patients with CP and NMS have high rates of hospital readmission; however, risk factors for readmission are not well established.
Univariate and multivariate analyses were used to compare the demographics, operative and postoperative course, radiographic characteristics, and preoperative Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaires of patients who did not require readmission to those who required either early readmission (within 90 days of the index surgery) or late readmission (readmission after 90 days).
Of the 218 patients identified, 19 (8.7%) required early readmission, while 16 (7.3%) required late readmission. Baseline characteristics were similar between the three cohorts. On univariate analysis, early readmission was associated with longer duration of surgery (p < 0.001) and larger magnitude of residual deformity (p = 0.003 and p = 0.029 for postoperative major and minor angles, respectively). The health score of the CPCHILD Questionnaire was lower in patients who required early readmission than in those who did not require readmission (p = 0.032). On multivariate analysis, oral feeding status was inversely related to early readmission (less likely to require readmission), while decreasing lumbar lordosis and increasing length of surgery were related to an increased likelihood of early readmission.
In patients with CP and NMS, longer surgical time, larger residual major and minor Cobb angles, lumbar lordosis, feeding status, and overall health may be related to a greater likelihood for early hospital readmission after elective spinal fusion. No factors were identified that correlated with an increased need for late hospital readmission after elective spinal fusion in patients with CP.
IV.
对前瞻性收集的接受脊柱融合术的脑瘫（CP）和神经肌肉型脊柱侧弯（NMS）儿科患者的多中心登记资料进行回顾性分析。
确定择期脊柱畸形手术后计划外再入院的危险因素。CP和NMS患者的医院再入院率较高；然而，再入院的危险因素尚未明确。
采用单因素和多因素分析，比较未需要再入院的患者与需要早期再入院（在首次手术90天内）或晚期再入院（90天后再入院）的患者的人口统计学、手术及术后病程、影像学特征以及术前照顾者优先事项和儿童残疾生活健康指数（CPCHILD）问卷情况。
在确定的218例患者中，19例（8.7%）需要早期再入院，16例（7.3%）需要晚期再入院。三组队列的基线特征相似。单因素分析显示，早期再入院与手术时间较长（p < 0.001）以及残余畸形程度较大有关（术后主要和次要角度分别为p = 0.003和p = 0.029）。需要早期再入院的患者CPCHILD问卷的健康评分低于未需要再入院的患者（p = 0.032）。多因素分析显示，经口喂养状况与早期再入院呈负相关（再入院可能性较小），而腰椎前凸减小和手术时间延长与早期再入院可能性增加有关。
在CP和NMS患者中，手术时间较长、残余主要和次要Cobb角较大、腰椎前凸、喂养状况和整体健康状况可能与择期脊柱融合术后早期医院再入院的可能性较大有关。未发现与CP患者择期脊柱融合术后晚期医院再入院需求增加相关的因素。
IV级。
