Clinical neurology and neurosurgery · 2019
30-day Outcomes in Primary vs. Revision Posterior Spinal Fusion for Pediatric Spinal Deformity.
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Malik Azeem Tariq, Yu Elizabeth, Kim Jeffery, Khan Safdar N
Аннотация
OBJECTIVES: Current evidence, with regard to primary vs. revision spinal fusions in pediatric spine deformities, is limited to inpatient outcomes only. The current study aims to analyze and compare 30-day outcomes in pediatric spine deformity patients undergoing a primary vs. a revision posterior spinal fusion.
PATIENTS AND METHODS: The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology (CPT) codes for patients undergoing posterior spinal fusions (22800, 22802 and 22804). Patients undergoing concurrent anterior fusion/combined fusion and anterior-only fusions were removed from the study. Revision spinal fusions were captured using CPT codes for re-insertion of spinal fixation device (22830), exploration of spinal fusions (22849), 22850 and 22852 (removal of posterior instrumentation).
RESULTS: Out of a total of 13,398 patients, 332 (2.5%) underwent a revision posterior spinal fusion and the remained underwent primary spinal fusion. Following adjustment for baseline clinical characteristics, patients undergoing revision posterior spinal fusions were at a higher risk of deep surgical site infections (OR 2.43 [95% CI 1.10-5.35]; p = 0.028), organ/space surgical site infections (OR 4.09 [1.19-14.04]; p = 0.025) and 30-day unplanned re-operations (OR 1.87 [95% CI 1.17-3.00].
CONCLUSIONS: Pediatric spine deformity patients undergoing revision spinal fusions are at a higher risk of experiencing wound-complications and subsequent unplanned re-operations within 30-days of surgery. Providers should promote careful wound-care and/or awareness among care-givers to minimize the risks and costs associated with these specific adverse outcomes.
PATIENTS AND METHODS: The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database was queried using Current Procedural Terminology (CPT) codes for patients undergoing posterior spinal fusions (22800, 22802 and 22804). Patients undergoing concurrent anterior fusion/combined fusion and anterior-only fusions were removed from the study. Revision spinal fusions were captured using CPT codes for re-insertion of spinal fixation device (22830), exploration of spinal fusions (22849), 22850 and 22852 (removal of posterior instrumentation).
RESULTS: Out of a total of 13,398 patients, 332 (2.5%) underwent a revision posterior spinal fusion and the remained underwent primary spinal fusion. Following adjustment for baseline clinical characteristics, patients undergoing revision posterior spinal fusions were at a higher risk of deep surgical site infections (OR 2.43 [95% CI 1.10-5.35]; p = 0.028), organ/space surgical site infections (OR 4.09 [1.19-14.04]; p = 0.025) and 30-day unplanned re-operations (OR 1.87 [95% CI 1.17-3.00].
CONCLUSIONS: Pediatric spine deformity patients undergoing revision spinal fusions are at a higher risk of experiencing wound-complications and subsequent unplanned re-operations within 30-days of surgery. Providers should promote careful wound-care and/or awareness among care-givers to minimize the risks and costs associated with these specific adverse outcomes.