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Does neurofibromatosis 1 status impact outcomes for pediatric/young adults undergoing spinal fusion?
Isaac Freedman1, Andrew Koo1, Erin Yeagle1
1Department of Neurological Surgery, Yale University, New Haven, Connecticut.
Insights
Spinal fusion outcomes in neurofibromatosis type 1 (NF1) patients are similar to non-NF1 patients after adjusting for confounding factors. NF1 status does not independently predict complications or hospital discharge in pediatric and young adult spinal fusion surgery.
Area of Science:
- Orthopedics
- Genetics
- Pediatric Surgery
Background:
- Spinal deformities are common in patients with neurofibromatosis type 1 (NF1).
- Limited data exists on the impact of NF1 on spinal fusion surgery outcomes in pediatric/young adult patients.
Purpose of the Study:
- To compare spinal fusion surgery outcomes between pediatric/young adult patients with and without NF1.
- To identify if NF1 is an independent predictor of adverse surgical outcomes.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (2005-2014) for spinal fusion patients ≤26 years.
- Comparison of demographics, comorbidities, and perioperative variables between NF1 and non-NF1 patients.
- Propensity score (PS)-matching to control for confounding factors and multivariate regression analyses.
Main Results:
- NF1 patients were younger, had more anterior approaches, more fused vertebrae, and longer length of stay (LOS) pre-matching.
- After PS-matching, all significant differences between NF1 and non-NF1 groups disappeared.
- NF1 status was not a significant independent predictor of LOS or nonroutine discharge.
Conclusions:
- NF1 status is not an independent predictor of complications, adverse postoperative events, longer LOS, or nonroutine hospital discharge in pediatric/young adult spinal fusion.
- Further prospective studies are needed to fully elucidate outcomes in NF1 patients undergoing spinal fusion.
Background:
Although spinal deformities are common in patients with neurofibromatosis type 1 (NF1), there is a paucity of data as to how this impacts outcomes of spinal fusion surgery in pediatric/young adult patients.
Methods:
Using the Nationwide Inpatient Sample (2005-2014) for all patients undergoing spinal fusion ≤26 years of age, we compared the following factors: demographics, comorbidities, and perioperative variables (e.g., between NF1 vs. non-NF1, and between NF1 and propensity score (PS)-matched non- NF1 spinal fusion patients) using univariate hypothesis tests and multivariate regression analyses. Our main interest focused on length of stay, complication rates, adverse postoperative events, and incidence of nonroutine discharges.
Results:
In this study, 238 (0.92%) NF1 spine patients were compared to 25,558 (99.08%) non-NF1 spine patients. NF1 fusion patients were younger, included fewer females, and were more likely to be on Medicaid. Perioperatively, NF1 patients underwent more anterior approaches, had more vertebrae fused, required more transfusions, had a longer length of stay (LOS), and were less likely to be discharged home. However, after PS- matching, all differences between NF1 and non-NF1 groups disappeared were similar (P > 0.05). In PS-matched multivariate analyses, NF1-status was not a significant independent predictor of length of stay or nonroutine discharge disposition.
Conclusion:
NF1-status was, therefore, not an independent predictor of complications, adverse postoperative events, longer LOS, or nonroutine hospital discharge in this cohort analysis. Further prospective studies are necessary to understand how outcomes in patients with NF1 compare to non-NF1 pediatric and young adult patients.
