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Fixation to Pelvis in Pediatric Spine Deformity-An Analysis of 30-Day Outcomes

Azeem Tariq Malik1, Jeffery Kim1, Elizabeth Yu1

  • 1Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

World Neurosurgery
|September 28, 2018
PubMed

Insights

Pelvic fixation during pediatric posterior spinal fusions increases the risk of 30-day complications, including infections, renal issues, and bleeding. This finding contrasts with adult literature and highlights the need for careful patient selection and counseling.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Spine Deformities
  • Surgical Outcomes Research

Background:

  • Posterior spinal fusions are common procedures for pediatric spine deformities.
  • The role and impact of pelvic fixation in pediatric cases require further investigation.
  • Understanding short-term outcomes is crucial for surgical decision-making.

Purpose of the Study:

  • To evaluate the association between pelvic fixation and 30-day postoperative outcomes in pediatric patients undergoing posterior spinal fusions.
  • To identify specific adverse events associated with pelvic fixation in this population.

Main Methods:

  • Retrospective analysis of the 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program pediatric database.
  • Inclusion of patients undergoing posterior spinal fusions (CPT codes 22800, 22802, 22804).
  • Exclusion of patients with concurrent anterior/combined or anterior-only fusions; identification of pelvic fixation via CPT code 22848.

Main Results:

  • Out of 13,398 patients, 1092 (8.2%) had pelvic fixation.
  • Pelvic fixation was associated with increased length of stay (OR 1.24).
  • Significantly higher odds of 30-day complications, including pneumonia (OR 1.85), renal insufficiency (OR 6.87), acute renal failure (OR 14.23), UTI (OR 1.99), cardiac arrest (OR 2.98), sepsis (OR 2.25), and bleeding (OR 1.51).
  • Increased odds of 30-day readmissions (OR 1.39) and reoperations (OR 1.37) were also observed.

Conclusions:

  • Pediatric patients undergoing pelvic fixation face higher risks of adverse 30-day outcomes compared to adults.
  • These findings underscore the importance of preoperative counseling and risk stratification.
  • Data suggest a need for careful consideration of pelvic fixation in pediatric spine surgery to enhance postoperative care quality.
Abstract

Keywords:
30-day outcomesComplicationsNSQIPPediatric spinePelvic fixationPosterior spinal fusion

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