Miskiewicz Michael J, Parsa Shabnam, Magruder Matthew, Abdelgawad Amr
Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, USA.
Department of Surgery, Stony Brook University, Stony Brook, USA.
Cureus. 2024 Jun 17;16(6):e62520. doi: 10.7759/cureus.62520. eCollection 2024 Jun.
Background Cerebral palsy (CP) is one of the most common neuromuscular disorders in children, and spinal abnormalities are vastly more common in people with CP compared to the general population. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative complications. This study aims to investigate (1) whether pediatric CP patients have higher rates of postoperative complications after spinal fusion and (2) risk factors for postoperative bleeding, readmission, and reoperation. Methodology The 2019 American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used for this study. Chi-square tests were used to compare patient demographics, frequency of comorbidities, intraoperative factors, and postoperative complications between CP and non-CP patients. Multivariable logistic regression modeling was conducted to determine if CP was an independent risk factor for the composite variable that included postoperative bleeding, readmission, and reoperation. Results A total of 4,445 patients were included in the study, with 606 CP and 3,839 non-CP patients. Several comorbidities were more prevalent in the CP cohort, most notably asthma, gastrointestinal disease, previous cardiac surgery, and hematologic disorders. Multivariable logistic regression modeling revealed that CP, older age, non-Caucasian race, American Society of Anesthesiologists (ASA) class of 3 or higher, posterior surgical approach, previous cardiac surgery, and ostomy were significantly correlated with higher postoperative complications. Conclusions This study demonstrates that CP, older age, non-Caucasian race, ASA class of 3 or higher, posterior approach, previous cardiac surgery, and ostomy are independent risk factors for postoperative complications, including readmission, reoperation, and postoperative bleeding requiring transfusions. Consequently, there is a pressing need for additional research to establish perioperative strategies that reduce postoperative risks for these patients. Spine surgeons should consider the findings of this study when communicating the potential risks of spinal fusion surgery with patients and their families.
脑瘫（CP）是儿童中最常见的神经肌肉疾病之一，与普通人群相比，脊柱异常在脑瘫患者中更为常见。需要进一步研究以增进我们对使脑瘫患儿术后并发症风险更高的围手术期因素的理解。本研究旨在调查：（1）小儿脑瘫患者在脊柱融合术后是否有更高的术后并发症发生率；（2）术后出血、再次入院和再次手术的危险因素。方法：本研究使用了2019年美国外科医师学会国家外科质量改进计划儿科数据库。采用卡方检验比较脑瘫患者和非脑瘫患者的人口统计学特征、合并症频率、术中因素及术后并发症。进行多变量逻辑回归建模以确定脑瘫是否是包括术后出血、再次入院和再次手术在内的复合变量的独立危险因素。结果：本研究共纳入4445例患者，其中606例为脑瘫患者，3839例为非脑瘫患者。几种合并症在脑瘫队列中更为普遍，最显著的是哮喘、胃肠道疾病、既往心脏手术和血液系统疾病。多变量逻辑回归建模显示，脑瘫、年龄较大、非白种人、美国麻醉医师协会（ASA）分级为3级或更高、后路手术入路、既往心脏手术和造口术与术后并发症发生率较高显著相关。结论：本研究表明，脑瘫、年龄较大、非白种人、ASA分级为3级或更高、后路入路、既往心脏手术和造口术是术后并发症（包括再次入院、再次手术和需要输血的术后出血）的独立危险因素。因此，迫切需要开展更多研究以制定降低这些患者术后风险的围手术期策略。脊柱外科医生在与患者及其家属沟通脊柱融合手术的潜在风险时应考虑本研究的结果。
