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Comorbidities and Complications of Spinal Fusion for Scoliosis
Jay G Berry1, Michael Glotzbecker2, Jonathan Rodean3
1Complex Care Service, Division of General Pediatrics, Department of Medicine, jay.berry@childrens.harvard.edu.
Insights
Children with complex medical conditions undergoing spinal fusion face increased hospital stays, costs, and readmissions. Chronic respiratory insufficiency, bladder dysfunction, and epilepsy significantly impact resource use and outcomes.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Clinical Outcomes Research
Background:
- Children with medical complexity (CMC) require specialized care during major surgeries like spinal fusion.
- Optimizing comorbid conditions is crucial for managing high-cost, high-morbidity procedures in CMC.
- Understanding the impact of specific chronic conditions on resource utilization is essential for pediatric healthcare providers.
Purpose of the Study:
- To assess the relationship between specific chronic conditions in CMC and hospital resource utilization during spinal fusion.
- To identify which comorbid conditions are most strongly associated with increased length of stay, cost, and readmission rates.
- To inform perioperative care strategies for children undergoing spinal fusion.
Main Methods:
- Retrospective analysis of 7252 children (age ≥5 years) undergoing spinal fusion across 41 children's hospitals (2010-2014).
- Comparison of hospital length of stay (LOS), cost, and 30-day readmission rates across various comorbid conditions.
- Utilized linear and logistic regression, controlling for demographics and hospital clustering.
Main Results:
- Increasing numbers of chronic conditions correlated with significantly higher median LOS, hospital costs, and readmission rates.
- Chronic respiratory insufficiency and bladder dysfunction were strongly associated with increased LOS and cost.
- Bladder dysfunction and epilepsy showed the highest likelihood of 30-day readmissions.
Conclusions:
- Chronic respiratory insufficiency, bladder dysfunction, and epilepsy are key factors influencing hospital resource use in CMC undergoing spinal fusion.
- These findings can guide pediatricians, hospitalists, and families in optimizing perioperative care for improved outcomes.
- Targeted management of these specific comorbidities may reduce healthcare costs and improve patient recovery.
Background And Objectives:
General pediatricians and hospitalists are increasingly summoned to optimize the comorbid conditions of children with medical complexity (CMC) undergoing major surgery. We assessed the relationship between specific chronic conditions of CMC and hospital resource use with spinal fusion for scoliosis, an operation with high cost and morbidity.
Methods:
Retrospective analysis of 7252 children age ≥5 years with an underlying complex chronic condition undergoing spinal fusion between January 1, 2010 through December 31, 2014 in 41 children's hospitals. Hospital length of stay (LOS), cost, and 30-day readmission rate were compared across comorbid conditions by using linear and logistic regression accounting for demographic characteristics and clustering of patients by hospital.
Results:
Fifty-nine percent of children had ≥4 comorbid conditions. As the number of chronic conditions increased from 1-3 to ≥10, median LOS increased 60% (5 [interquartile range (IQR), 4-7] to 8 [IQR, 5-13] days); median hospital cost increased 53% ($52 319 [IQR, $37 937-71 513] to $80 429 [IQR, $58 602-$111 965]); and readmission rates increased 293% (5.4% to 15.8%) (P < .001 for all). In multivariable analysis, conditions strongly associated with LOS and cost were chronic respiratory insufficiency (LOS: +2.1 days; cost: +$12 070; and bladder dysfunction (LOS: +0.8 days; cost: +$4014) (P < .001 for all). Readmission likelihood was highest with bladder dysfunction (odds ratio, 1.5; 95% confidence interval, 1.1-2.0) and epilepsy (odds ratio, 1.2; 95% confidence interval, 1.0-1.5).
Conclusions:
Chronic respiratory insufficiency, bladder dysfunction, and epilepsy had significant associations with hospital resource use for CMC undergoing spinal fusion. Pediatricians, patients, and families may find it useful to consider these conditions when striving to benefit the children's perioperative health and outcomes.
