The prognostic value of preoperative pulmonary function tests in adolescent idiopathic scoliosis surgery.

PURPOSE: The purpose of this study is to evaluate whether preoperative pulmonary function tests (PFTs) can predict the need for postoperative intensive care following adolescent idiopathic scoliosis (AIS) surgery, and to explore their associations with postoperative respiratory support, transfusion requirement, inotropic support, duration of hospital stay and scoliosis severity. METHODS: In this retrospective cohort study, we included 202 patients who underwent posterior spinal fusion for AIS between 2019 and 2024. Patients were grouped by their preoperative PFT forced vital capacity (FVC) Z-scores into the following categories: normal (Z-FVC ≥ -1.645), mild (-1.645 > Z-FVC ≥ -2.5), moderate (-2.5 > Z-FVC ≥ -4) and severe impairment (Z-FVC < -4). Demographic and clinical variables including scoliosis severity indicators, perioperative blood transfusion requirements, postoperative respiratory support, inotropic support needs, and intensive care unit (ICU) and hospital stay durations were compared across groups. Statistical significance was set at p < 0.05. RESULTS: After applying the exclusion criteria, 163 patients were included in the final analysis. Overall, 37 of 163 patients (22.7%) required postoperative ICU admission. Groups differed significantly in Cobb angle, kyphosis angle and number of affected vertebrae (p = 0.001, p = 0.001 and p = 0.003, respectively). Increasing pulmonary impairment was associated with higher rates of ICU admission, bilevel positive airway pressure (BiPAP) use, postoperative intubation, and extended ICU and hospital stays (p = 0.001), as well as greater need for inotropic support (p = 0.045) and higher mortality (p = 0.019). Intraoperative blood transfusion rates (p = 0.004) and the number of units transfused (p = 0.002) also varied significantly across groups. CONCLUSION: Preoperative PFTs are associated with scoliosis severity, intraoperative transfusion requirements, and postoperative outcomes in AIS surgery. These findings suggest that preoperative PFTs could be a valuable prognostic tool for postoperative management following AIS surgery. TRIAL REGISTRATION: NCT06756880/ https://www.clinicaltrials.gov/ (24/12/2024).