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Preoperative Variables Associated With Respiratory Complications After Pediatric Neuromuscular Spine Deformity

Scott J Luhmann¹, Ryan Furdock¹

¹Pediatric Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.

Spine Deformity

|December 28, 2018

Insights

Pediatric neuromuscular scoliosis patients with a history of pneumonia or a gastrostomy tube face higher risks of respiratory complications after spinal fusion surgery. These factors are key predictors of adverse outcomes.

Area of Science:

Pediatric Orthopedics
Spine Surgery
Respiratory Medicine

Background:

Posterior spinal fusion (PSF) in pediatric neuromuscular scoliosis (NMS) is a high-risk procedure.
Respiratory complications are the most frequent postoperative issue, affecting up to 28.2% of patients.

Purpose of the Study:

To identify preoperative patient factors and laboratory values linked to postoperative respiratory complications in pediatric NMS patients undergoing PSF.
To improve risk stratification and patient management for this vulnerable population.

Main Methods:

Retrospective review of a single-surgeon, two-hospital pediatric spine surgery database.
Inclusion of patients with NMS (cerebral palsy, myelomeningocele, spinal muscular atrophy) undergoing PSF.
Collection of preoperative laboratory values and assessment of respiratory complications defined by specific criteria.

Main Results:

15.3% of patients experienced postoperative respiratory complications.
Univariate analysis identified a history of pneumonia and gastrostomy tube presence as significant risk factors.
Multivariate analysis confirmed gastrostomy tube and pneumonia history as independent predictors of respiratory complications.

Conclusions:

Pediatric NMS patients with a history of pneumonia or a gastrostomy tube are at increased risk for respiratory complications following PSF.
Further investigation into the association of tracheostomy and low transferrin levels is warranted.

Read full analysis

Abstract

Objective:

The objective of this study is to identify preoperative laboratory values and patient factors that are associated with postoperative respiratory complications in pediatric neuromuscular scoliosis (NMS) populations undergoing posterior spinal fusion (PSF) with instrumentation.

Summary Of Background Data:

PSF in NMS patients are high-risk surgeries. Respiratory complications are the most common postoperative event, with rates up to 28.2% following surgery.

Methods:

A single-surgeon, two-hospital pediatric spine surgery database was reviewed to identify all patients who underwent PSF for NMS. Diagnoses included cerebral palsy (n=83), myelomeningocele (n=13), spinal muscular atrophy (n=4), and other (n=11). This study defined respiratory complications as postoperative pneumonia, pleural effusion, pneumothorax, need for reintubation, respiratory status requiring a return to the pediatric intensive care unit (PICU), or prolonged (>4-day) need for mechanical ventilation. Preoperative laboratory values for transferrin, prealbumin, hemoglobin/hematocrit, total protein, albumin, and total lymphocyte count were collected.

Results:

There were 50 males and 61 females with a mean age of 14 years 2.5 months (8-20 years). Seventeen patients (15.3%) experienced postoperative respiratory complications. On univariate analysis, any history of pneumonia, the presence of gastrostomy tube, and low transferrin levels were associated with postoperative respiratory complications, and a strong trend (p=.06) was observed for tracheostomy. On multivariate analysis, the presence of gastrostomy tube and history of pneumonia remained as clinically significant predictors of postoperative respiratory complications.

Conclusion:

Pediatric NMS patients undergoing PSF that have history of pneumonia or gastrostomy tube present at time of surgery are at increased risk for postoperative respiratory complications. The univariate associations of tracheostomy presence and low transferrin levels with postoperative respiratory complications deserve further examination.

Level Of Evidence:

Level II.

Keywords:

Neuromuscular Respiratory complications Spinal fusion Spine deformity

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