Posterior spinal fusion outcomes in adolescent idiopathic scoliosis patients with attention deficit hyperactivity disorder (ADHD): ADHD subtype makes a difference.

PURPOSE: To determine whether attention-deficit/hyperactivity disorder (ADHD) and its subtypes of hyperactive/impulsive ADHD (ADHD-h) and inattentive ADHD (ADHD-i) are associated with differential 90-day postoperative complications and healthcare utilization following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

METHODS

AIS patients who underwent PSF were identified from the 2010-Q1 2023 PearlDiver M170 database. Patients were stratified into four groups based on preoperative ADHD status: ADHD-h, ADHD-i, ADHD unspecified or combined type, and non-ADHD. A pooled ADHD cohort including ADHD-h, ADHD-i, and ADHD unspecified or combined type patients was also created. The ADHD-h, ADHD-i, and pooled ADHD cohorts were each independently matched 1:4 with non-ADHD controls. Exclusion criteria included: age < 10 or > 18 years, fusion to pelvis, and < 90-d follow-up. Ninety-day aggregated any, severe, and minor adverse events (AAE, SAE, MAE), specific adverse events, hospital readmissions, and emergency department (ED) visits for each ADHD group were compared to their matched non-ADHD control group using multivariable analysis.

RESULTS

Of 14,466 AIS patients undergoing PSF, ADHD-h was noted for 908 (6.28%) and ADHD-i was noted for 409 (2.83%). Relative to matched non-ADHD controls, ADHD-h patients demonstrated an increased odds ratio (OR) of 90-day ED visits (OR 1.89, p < 0.001) and urinary tract infections (UTI) (OR 1.54, p = 0.048). Relative to matched non-ADHD controls, ADHD-i patients demonstrated reduced odds of AAE (OR: 0.59, p = 0.006), MAE (OR 0.52, p = 0.002), transfusion (OR 0.50, p = 0.035), and hospital readmission (OR 0.49, p = 0.013). Overall, the pooled ADHD cohort demonstrated increased odds of ED visits (OR 1.58, p < 0.001), increased odds of UTI (OR 1.41, p < 0.05), and reduced odds of transfusion (OR 0.73, p < 0.05) compared with matched non-ADHD controls.

CONCLUSION

Among AIS patients undergoing PSF, ADHD-h was associated with increased odds of 90-day defined adverse events, whereas ADHD-i was associated with decreased odds of various adverse events and hospital readmission. The pooled ADHD cohort demonstrated a net increase in ED utilization and UTI risk-likely driven by the ADHD-h subgroup. These findings may be useful in refining perioperative care pathways.

LEVEL OF EVIDENCE: Level III.