In-hospital outcomes following fusion for spinal deformity in children with spinal cord injury: Analysis using the National Inpatient Sample.

OBJECTIVE

To evaluate hospital outcomes of surgical corrections of spinal deformity in children with spinal cord injury (SCI).

STUDY

DESIGN

: Cross-sectional study.

SETTING

National Inpatient Sample (1998-2021) was used to identify in-hospital outcomes of spinal fusion for spinal deformity.

PARTICIPANTS

: 768 children (0-17) with SCI.

INTERVENTIONS: : Not applicable.

OUTCOMES MEASURES: Critical care intervention (CCI) complications, hospital length of stay, charges, and discharge disposition. Individual and hospital characteristics were noted.

RESULTS

Average age 14 (SD = 6), 48% females, 65% non-Hispanic White. Most cases were incomplete-SCI (38% thoracic, 31% cervical). Most surgeries occurred in large (66%) and urban teaching (93%) hospitals. A quarter received CCI and 43% developed complications. Median length of stay was 8 days (interquartile range: 5-14) and median charges were $230,136 (interquartile range: $150,131-$356,481). Mortality was low (<2%) and 41% were discharged to home healthcare or a medical facility. Having three or more comorbidities was associated with worse outcomes. Children on Medicaid were more likely to receive CCI. Older age, comorbidities, income, injury completeness, and bone fracture increased the likelihood of discharge to more care.

CONCLUSION

Spinal fusion for spinal deformity in children with SCI results in significant morbidity, prolonged hospital stays, substantial charges, and frequent post-discharge care. These findings underscore the significant healthcare burden and morbidity associated with spinal fusion for spinal deformity in children with SCI, emphasizing the need for optimized perioperative management and long-term follow-up. Future research should evaluate longitudinal outcomes. Altogether, it would guide restorative programs aiming to prevent or slow deformity progression.