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Risk factors for postoperative pulmonary complications in children with severely compromised pulmonary function
Montaha M Al-Iede1, Enas Al-Zayadneh1, Corinne Bridge2
1Department of Pediatrics, The University of Jordan, Amman, Jordan.
Insights
Noninvasive ventilation (NIV) use before scoliosis surgery in children with severely compromised pulmonary function (SCPF) was linked to fewer postoperative complications and shorter hospital stays. This finding highlights NIV
Area of Science:
- Pediatric Surgery
- Pulmonology
- Respiratory Medicine
Background:
- Postoperative pulmonary complications are a significant concern following scoliosis corrective surgery, increasing morbidity, hospital stay, and mortality.
- Identifying risk factors and effective interventions for these complications is crucial for improving patient outcomes.
Purpose of the Study:
- To identify factors associated with severely compromised pulmonary function (SCPF) in children undergoing scoliosis surgery.
- To assess the effectiveness of noninvasive ventilation (NIV) in reducing postoperative pulmonary complications and length of hospital stay (LOS) in these patients.
Main Methods:
- Retrospective cohort study of children (≤17 years) who underwent spinal surgery for scoliosis.
- Data collection included polysomnography (PSG) and NIV use, pre- and post-surgery.
- Analysis of factors associated with SCPF and correlation with postoperative complications and LOS.
Main Results:
- 133 children underwent scoliosis surgery; 13.5% had SCPF.
- Factors associated with SCPF included markers of sleep hypoventilation.
- Postoperative pulmonary complications occurred in 18% and correlated with higher Cobb angle, lower pulmonary function, higher serum bicarbonate, and neuromuscular disease.
- Among children with SCPF, preoperative NIV use was associated with reduced postoperative complications (P=.02) and LOS by 6.4 days (P=.01).
Conclusions:
- Nocturnal hypoventilation on PSG can identify children with SCPF.
- Preoperative NIV use in children with SCPF is linked to fewer postoperative pulmonary complications and reduced hospital stay.
Objectives:
After corrective surgery for scoliosis, postoperative pulmonary complications lead to increases in morbidity, length of hospital stay (LOS) and mortality. This study aimed to identify associations with such respiratory complications, and to assess the utility of noninvasive ventilation (NIV) in children with severe scoliosis METHODS: This retrospective cohort study included all children aged ≤17 years who underwent spinal surgery for scoliosis between January 2009 and January 2012 at a quaternary pediatric hospital. Data were collated regarding polysomnography (PSG) and NIV use, before and after corrective surgery. Factors associated with severely compromised pulmonary function (SCPF) were established and correlations with the occurrence of postoperative pulmonary complications and LOS were identified.
Results:
Altogether, 133 children had corrective surgery for scoliosis, aged 12.7 (range: 2-17) years at operation. Scoliosis causes were identified as: idiopathic (39.8%), neuromuscular disease (32.2%), syndrome (15.7%), and congenital (12%). Correlates with SCPF (forced vital capacity [FVC] <40% predicted, n = 10) included markers of sleep hypoventilation, including serum bicarbonate ≥29 mmol/L, morning pCO2 > 50mm Hg (P = .003), and overnight, episodic CO2 retention of >7 mm Hg. Using these parameters an additional eight children with SCPF were identified making a total of 18 out of 133 (13.5%) of the patients. Postoperative pulmonary complications were seen in 24 children (18%) and their occurrence correlated with higher Cobb angle (>90°), lower pulmonary function (FVC), higher serum bicarbonate and underlying neuromuscular disease. Amongst the 18 children with SCPF, regular use of NIV preoperatively was associated with reduced rate of postoperative pulmonary complications (P = .02) and reduced LOS by 6.4 days (P = .01).
Conclusion:
Nocturnal hypoventilation on PSG identifies children with SCPF. Use of NIV in children with SCPF was linked to fewer postoperative pulmonary complications and reduced duration of hospital stay.
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