Age matters: increased perioperative morbidity in young adults compared to adolescents undergoing posterior spinal fusion for idiopathic scoliosis.

BACKGROUND

The purpose of this study was to compare perioperative outcomes between adolescents and young adults undergoing posterior spinal fusion for idiopathic scoliosis using a large clinical registry.

METHODS

This was a retrospective cohort study using data from the NSQIP and NSQIP-Pediatric databases from 2016 to 2024. Patients aged 10-40 years who underwent posterior spinal fusion for idiopathic scoliosis were included. Two study cohorts were defined: (1) adolescent idiopathic scoliosis (AIS) (10-17 years) and (2) young adult idiopathic scoliosis (YADIS) (18-40 years). Outcomes included operative time, length of stay (LOS), allogeneic transfusion, any adverse event, 30-day readmission, 30-day reoperation, and non-home discharge. Groups were compared using chi-square test and Student's t-test. Multivariable regression analyses were performed controlling for sex, ASA, and number of fusion levels.

RESULTS

There were 31,120 AIS patients (mean age 14.5 years) and 439 YADIS patients (mean age 21.9 years). Compared with the AIS cohort, YADIS had significantly longer operative times (AIS: 276.4 min vs YADIS: 353.7 min; p < 0.001) and longer LOS (AIS: 3.4 days vs YADIS: 5.1 days; p < 0.001). The YADIS cohort had higher rates of allogeneic transfusion (AIS: 10.9% vs YADIS: 33.3%; p < 0.001), any adverse event (AIS: 1.6% vs YADIS: 3.0%; p = 0.03), reoperation (AIS: 1.3% vs YADIS: 2.5%; p = 0.03), and non-home discharge (AIS: 0.4% vs YADIS: 2.7%; p < 0.001). There was no significant difference in readmission (AIS: 1.7% vs YADIS: 2.7%; p = 0.10). In multivariable logistic regression analyses, the YADIS cohort had higher odds of allogeneic transfusion (OR 4.8, p < 0.001), reoperation (OR 1.9, p = 0.04), any adverse event (OR 1.8, p = 0.04), and non-home discharge (OR 7.19, p < 0.001). In multivariable linear regression analyses, YADIS was associated with longer operative time (+ 78.9 min, p < 0.001) and length of stay (+ 1.7 days, p < 0.001).

CONCLUSION

Compared with adolescents, young adults undergoing posterior spinal fusion for idiopathic scoliosis experience greater perioperative morbidity and resource utilization. These findings highlight important age-related differences that should be considered during surgical decision-making.