Goheer Haseeb E, Yang Phillip T, Ghattas Yasmine S, Ramirez Gabriel, Haddas Ram, Dubina Andrew G, Nelson Susan E, Puvanesarajah Varun
Department of Orthopaedic Surgery and Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA.
Spine Deform. 2025 Jun 23. doi: 10.1007/s43390-025-01129-5.
Cerebral palsy (CP) patients with severe scoliosis are frequently malnourished. However, there is a paucity of literature focusing on the impact of pediatric malnutrition indicators on post-operative surgical complications. This study aims to examine the relationship between measures of nutritional status and their ability to predict post-operative complications in patients with CP undergoing spinal fusion for neuromuscular scoliosis.
The American College of Surgeons National Surgical Quality Improvement Program Pediatric was queried retrospectively to identify pediatric CP patients who had undergone spinal fusions for neuromuscular scoliosis between 2016 and 2022 using the Current Procedural Terminology Code 22804. Univariate and multivariate regression were employed to assess differences in preoperative patient characteristics as well as postoperative complications across malnutrition definitions (stunting, wasting, and requiring nutritional support).
A total of 2017 patients were identified between 2016 and 2022, of which 1124 received nutritional support and 893 did not. Among all patients, 93.3% (n = 1882) met at least one definition of malnutrition, 58.1% (n = 1172) met two or more definitions, and 9.3% (n = 187) met all three definitions of malnutrition. After adjustment, requiring nutritional support independently increased the risk for an extended intensive care unit stay (OR:1.35; 95 CI [1.01-1.83]; p = 0.047). Wasting independently increased the risk for unplanned intubation (OR:1.77; 95 CI [1.02-3.02]; p = 0.038) while stunting increased the risk for deep/organ space surgical site infection (OR:2.50; 95 CI [1.20-6.10]; p = 0.025).
Patients with malnutrition (defined as nutritional support) are at increased risk for an extended intensive unit care stay in the postoperative period. Personalized postoperative management with multidisciplinary teams, guided by risk assessment, may help mitigate postoperative complications and address the challenges associated with malnutrition.
III.
患有严重脊柱侧弯的脑瘫（CP）患者常伴有营养不良。然而，关注儿童营养不良指标对术后手术并发症影响的文献较少。本研究旨在探讨营养状况指标与预测接受神经肌肉型脊柱侧弯脊柱融合术的CP患者术后并发症能力之间的关系。
回顾性查询美国外科医师学会国家外科质量改进计划儿科数据库，以识别2016年至2022年间使用当前手术操作术语代码22804接受神经肌肉型脊柱侧弯脊柱融合术的儿科CP患者。采用单因素和多因素回归分析来评估术前患者特征以及不同营养不良定义（发育迟缓、消瘦和需要营养支持）下术后并发症的差异。
2016年至2022年间共识别出2017例患者，其中1124例接受了营养支持，893例未接受。在所有患者中，93.3%（n = 1882）符合至少一种营养不良定义，58.1%（n = 1172）符合两种或更多定义，9.3%（n = 187）符合所有三种营养不良定义。调整后，需要营养支持独立增加了延长重症监护病房住院时间的风险（比值比：1.35；95%置信区间[1.01 - 1.83]；p = 0.047）。消瘦独立增加了非计划插管的风险（比值比：1.77；95%置信区间[1.02 - 3.02]；p = 0.038），而发育迟缓增加了深部/器官间隙手术部位感染的风险（比值比：2.50；95%置信区间[1.20 - 6.10]；p = 0.025）。
营养不良（定义为需要营养支持）的患者术后延长重症监护病房住院时间的风险增加。在风险评估的指导下，由多学科团队进行个性化的术后管理，可能有助于减轻术后并发症并应对与营养不良相关的挑战。
III级
