Berg Ari R, Shin John I, Leggett Andrew, Para Ashok, Mendiratta Dhruv, Kaushal Neil, Vives Michael J
Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA
Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ, USA.
Int J Spine Surg. 2024 Sep 12;18(4):375-382. doi: 10.14444/8614.
Approximately 50% of patients with congenital scoliosis will require surgical treatment to prevent further progression. Outcomes following congenital scoliosis are sparse in the literature. The purpose of this study was to identify independent risk factors associated with unplanned readmission and prolonged length of stay (LOS) in patients undergoing primary surgical treatment for congenital scoliosis.
The National Surgical Quality Improvement Database-Pediatric was queried for database years 2016-2018 to identify patients with congenital scoliosis who underwent primary posterior fusion of the spine. Patient demographics, comorbidities, and operative variables, such as the number of levels fused and the American Society of Anesthesiologists (ASA) classificaiton, were collected. Univariate and multivariate analyses of patient factors were performed to test for association with readmission within 30 days and prolonged LOS (>4 days).
Eight hundred sixteen patients were identified. The average age was 11.3 ± 4.02 years, and the mean postoperative LOS was 4.64 ± 3.71 days. Forty-three patients (5.40%) were readmitted, and 73 patients (8.96%) had prolonged LOS. Independent risk factors associated with prolonged LOS included chronic lung disease ( < 0.001), presence of a tracheostomy ( < 0.001), structural central nervous system abnormality ( = 0.039), oxygen support ( < 0.001), and number of levels fused ( = 0.008). The factors independently associated with unplanned readmission were fusion to the pelvis ( = 0.004) and LOS >4 days ( = 0.008).
Prolonged LOS and readmission are widely being used as quality and performance metrics for hospitals. Congenital scoliosis, which often progresses rapidly resulting in significant deformity, frequently requires surgery at an earlier age than idiopathic and neuromuscular deformity. Nevertheless, 30-day outcomes for surgical intervention have not been thoroughly studied. The present study identifies risk factors for prolonged LOS and readmission, which can facilitate preoperative planning, patient/family counseling, and postoperative care.
Congenital scoliosis management poses certain challenges that may be mitigated by understanding the risk factors for adverse outcomes following primary fusion surgery.
约50%的先天性脊柱侧凸患者需要手术治疗以防止病情进一步发展。关于先天性脊柱侧凸的手术结果，文献报道较少。本研究的目的是确定先天性脊柱侧凸一期手术治疗患者计划外再入院和住院时间延长的独立危险因素。
查询2016 - 2018年国家外科质量改进数据库 - 儿科版，以确定接受脊柱一期后路融合术的先天性脊柱侧凸患者。收集患者的人口统计学资料、合并症以及手术变量，如融合节段数和美国麻醉医师协会（ASA）分级。对患者因素进行单因素和多因素分析，以检验与30天内再入院和住院时间延长（>4天）的相关性。
共纳入816例患者。平均年龄为11.3±4.02岁，术后平均住院时间为4.64±3.71天。43例患者（5.40%）再次入院，73例患者（8.96%）住院时间延长。与住院时间延长相关的独立危险因素包括慢性肺病（<0.001）、气管造口术（<0.001）、中枢神经系统结构异常（=0.039）、氧疗（<0.001）和融合节段数（=0.008）。与计划外再入院独立相关的因素是融合至骨盆（=0.004）和住院时间>4天（=0.008）。
住院时间延长和再入院广泛用作医院质量和绩效指标。先天性脊柱侧凸通常进展迅速，导致严重畸形，往往比特发性和神经肌肉性畸形更早需要手术。然而，手术干预的30天结果尚未得到充分研究。本研究确定了住院时间延长和再入院的危险因素，这有助于术前规划、患者/家属咨询及术后护理。
先天性脊柱侧凸的治疗存在一定挑战，了解一期融合手术后不良结局的危险因素可能有助于缓解这些挑战。
