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Postoperative Mechanical Ventilation for Children With Medical Complexity Undergoing Spinal Fusion: A Pediatric

Jennifer M Perez1,2, Matt Hall3, Robert J Graham1,2

  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|September 11, 2025
PubMed

Insights

Approximately 13% of children with medical complexity required prolonged invasive mechanical ventilation (IMV) after spinal fusion. Underlying chronic conditions significantly influenced the duration of IMV, highlighting areas for potential care improvements.

Area of Science:

  • Pediatric critical care medicine
  • Spinal surgery outcomes
  • Medical complexity research

Background:

  • Children with medical complexity often have prolonged intensive care unit (ICU) stays after major surgeries.
  • Invasive mechanical ventilation (IMV) duration is a key indicator of postoperative recovery and resource utilization.
  • Factors influencing IMV duration in this population undergoing spinal fusion are not fully understood.

Purpose of the Study:

  • To determine the prevalence of prolonged postoperative IMV in children with medical complexity undergoing spinal fusion.
  • To identify patient-specific and systemic factors associated with the duration of IMV.
  • To explore regional variations in IMV utilization post-spinal fusion.

Main Methods:

  • Retrospective cohort study utilizing the Pediatric Health Information System database.
  • Inclusion criteria: patients aged 5-18 years with underlying neuromuscular or genetic disorders undergoing thoracic-lumbar spinal fusion for scoliosis.
  • Data collected on demographics, comorbidities, and postoperative ventilation duration across 47 U.S. children's hospitals.

Main Results:

  • 6.7% of 6511 eligible patients had pre-existing tracheostomy and ventilator dependence.
  • 5.7% and 7% of patients required IMV for 4-6 days and >=7 days, respectively.
  • Neurologic, respiratory, skin, hematologic, endocrine, genitourinary, and cardiac conditions were associated with increased odds of prolonged IMV (>=4 days). Preoperative tracheostomy was associated with lower odds.

Conclusions:

  • About 1 in 8 children with medical complexity required >=4 days of IMV post-spinal fusion.
  • Multiple chronic conditions across various organ systems are linked to prolonged IMV.
  • Further research into chronic conditions, clinical factors, and regional variations is needed to optimize care and reduce IMV duration.
Abstract

Keywords:
chronic diseaseintensive care unitsrespiratory systemscoliosisspinal fusiontracheostomy

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