Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej, 2100 Copenhagen, Denmark.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej, 2100 Copenhagen, Denmark.
Spine J. 2021 Apr;21(4):653-663. doi: 10.1016/j.spinee.2021.01.004. Epub 2021 Jan 8.
Extended length of stay (extLOS) and unplanned readmissions after first time pediatric spinal deformity surgery are a considerable challenge to both the patient and the health-care system. To our knowledge, only a limited number of nationwide studies reporting short-term comorbidity with complete follow-up exist.
The purpose of this study was to identify the postoperative complications leading to extLOS, readmissions, and mortality within 90 days after surgery. Furthermore, to identify risk factors for readmission.
Retrospective national cohort study.
A nationwide registry study including all pediatric spinal deformity patients (≤21 years of age) undergoing primary surgery during 2006-2015 (n=1,310).
Reasons for extLOS and 90-day readmissions as well as mortality risk.
Patients were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on length of stay (LOS), readmissions, and mortality within 90 days were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Reasons for extLOS and readmission were collected from medical records and discharge summaries.
For the 1,310 patients, the median LOS was 8 days (interquartile range 7-9). Etiologies were idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann kyphosis (5%), and syndromic deformity (3%). A total of 274 (21%) patients had extLOS and the most common reason was pain/mobilization issues but with considerable variation between etiologies; Scheuermann kyphosis (91%), idiopathic (59%), syndromic (44%), spondylolisthesis (38%), and congenital (30%). Pulmonary complications were the primary reason for extLOS in the neuromuscular group (22%). The 90-day readmission rate was 6%; 67% of readmissions were medical, mainly infections unrelated to the surgical site (23%); 33% of readmissions were surgical and 14% of patients required revision surgery. Neuromuscular deformity, spondylolisthesis, Scheuermann kyphosis, and LOS >9 days were independent risk factors for readmission; odds ratio (OR) 4.4 (95% confidence interval: 2.2-9.1, p<.01), OR 3.0 (1.1-8.0, p=.03), OR 4.9 (1.7-13.6, p<.01), and OR 1.8 (1.0-3.1, p=.04), respectively. The 90-day mortality risk was 0.4%.
In this nationwide cohort, pain/mobilization issues are the most common reason for extLOS. The most common reason for readmission is infection unrelated to the surgical site. Readmission after pediatric spinal surgery is related to the etiology and increased focus on patients operated for neuromuscular deformity, spondylolisthesis and Scheuermann kyphosis is warranted.
首次小儿脊柱畸形手术后的住院时间延长（extLOS）和计划外再入院是患者和医疗保健系统面临的重大挑战。据我们所知，仅有少数全国性研究报告了短期合并症并进行了完整随访。
本研究旨在确定导致 extLOS、再入院和术后 90 天内死亡的术后并发症。此外，确定再入院的风险因素。
回顾性全国队列研究。
包括所有在 2006-2015 年间接受初次手术的小儿脊柱畸形患者（≤21 岁）的全国登记研究（n=1310）。
extLOS 和 90 天再入院以及死亡率的原因。
通过丹麦国家患者登记处（DNPR）中的手术和诊断代码识别患者。从 DNPR 中检索住院时间（LOS）、再入院和 90 天内死亡率的数据。根据病因将患者分为六组。从病历和出院小结中收集 extLOS 和再入院的原因。
对于 1310 名患者，中位 LOS 为 8 天（四分位间距 7-9）。病因分别为特发性畸形（53%）、神经肌肉性畸形（23%）、先天性/结构性畸形（9%）、脊椎滑脱（7%）、Scheuermann 后凸（5%）和综合征性畸形（3%）。共有 274 名（21%）患者出现 extLOS，最常见的原因是疼痛/活动问题，但各病因之间存在相当大的差异；Scheuermann 后凸（91%）、特发性（59%）、综合征性（44%）、脊椎滑脱（38%）和先天性（30%）。肺部并发症是神经肌肉性畸形患者 extLOS 的主要原因（22%）。90 天再入院率为 6%；67%的再入院为医疗原因，主要为与手术部位无关的感染（23%）；33%的再入院为手术原因，14%的患者需要进行翻修手术。神经肌肉性畸形、脊椎滑脱、Scheuermann 后凸和 LOS>9 天是再入院的独立危险因素；比值比（OR）分别为 4.4（95%置信区间：2.2-9.1，p<.01）、3.0（1.1-8.0，p=.03）、4.9（1.7-13.6，p<.01）和 1.8（1.0-3.1，p=.04）。90 天死亡率为 0.4%。
在本全国性队列中，疼痛/活动问题是 extLOS 最常见的原因。再入院最常见的原因是与手术部位无关的感染。小儿脊柱手术后的再入院与病因有关，需要更加关注神经肌肉性畸形、脊椎滑脱和 Scheuermann 后凸患者。
