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30-day Outcomes in Primary vs. Revision Posterior Spinal Fusion for Pediatric Spinal Deformity

Azeem Tariq Malik1, Elizabeth Yu1, Jeffery Kim1

  • 1Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.

Clinical Neurology and Neurosurgery
|April 8, 2019
PubMed

Insights

Revision spinal fusions in pediatric spine deformities carry higher risks for surgical site infections and unplanned re-operations within 30 days compared to primary fusions. Careful wound care is crucial for these patients.

Area of Science:

  • Pediatric Orthopedics
  • Spine Surgery
  • Surgical Quality Improvement

Background:

  • Evidence on primary versus revision spinal fusions in pediatric spine deformities is limited to inpatient outcomes.
  • This study addresses the gap by analyzing 30-day outcomes for posterior spinal fusions.

Purpose of the Study:

  • To compare 30-day outcomes between primary and revision posterior spinal fusions in pediatric spine deformity patients.
  • To identify specific risks associated with revision spinal fusions.

Main Methods:

  • Utilized the 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database.
  • Identified patients undergoing posterior spinal fusions using CPT codes, excluding anterior or combined fusions.
  • Captured revision fusions using specific CPT codes for re-insertion, exploration, and removal of instrumentation.

Main Results:

  • Out of 13,398 patients, 332 (2.5%) underwent revision posterior spinal fusion.
  • Revision spinal fusions were associated with a significantly higher risk of deep surgical site infections (OR 2.43) and organ/space surgical site infections (OR 4.09).
  • Patients undergoing revision fusions also had a higher risk of 30-day unplanned re-operations (OR 1.87).

Conclusions:

  • Pediatric patients undergoing revision spinal fusions face increased risks of wound complications and unplanned re-operations within 30 days.
  • Emphasizes the need for meticulous wound care and heightened awareness among caregivers to mitigate these adverse outcomes.
  • Highlights potential cost savings and improved patient safety through focused post-operative management.
Abstract

Keywords:
30-day outcomesDeformityPediatricPosterior spinal fusionPrimaryRevisionScoliosis

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