Impact of Age at Surgery on Perioperative Outcomes After Posterior Spinal Fusion for Neuromuscular Scoliosis.

BACKGROUND

While surgical outcomes for posterior spinal fusion (PSF) for pediatric patients with neuromuscular scoliosis (NMS) have been well described, less is known about how perioperative outcomes differ when surgery is performed later, during young adulthood. The purpose of this study was to compare perioperative outcomes between adolescents and young adults undergoing PSF for NMS using a large, multi-institutional clinical registry.

METHODS

A retrospective cohort study was performed using the National Surgical Quality Improvement Program (NSQIP) and NSQIP-Pediatric databases from 2016 to 2024. Patients aged 10-40 years who underwent PSF for NMS were included. Two cohorts were defined: adolescents (aged 10-17 years) and young adults (aged 18-40 years). Outcomes of interest included operative time, length of stay (LOS), allogeneic transfusion, any adverse event, 30-day readmission, and non-home discharge. Outcomes were compared between the two groups using the chi-squared test and Student's t-test. Multivariable logistic and linear regression analyses were performed adjusting for sex, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and the number of fusion levels.

RESULTS

There were 8,005 adolescent patients (mean age: 13.8 years) and 69 young adult patients (mean age: 20.5 years) who met inclusion criteria. Compared with adolescents, young adults experienced significantly longer operative times (350.4 vs 422.9 min, P < .001). Young adults also had higher rates of non-home discharge (4.9% vs 10.1%, P = .04) and any adverse event (13.3% vs 24.6%, respectively, P = .006). No significant differences were observed in mean LOS, rate of unplanned readmission, or rate of allogeneic transfusion. On multivariable logistic regression, surgery in young adulthood was independently associated with increased odds of any adverse event (odds ratio [OR]: 2.3, P = .003), allogeneic transfusion (OR: 1.7, P = .03), and non-home discharge (OR: 2.3, P = .04). Multivariable linear regression demonstrated that surgery in young adulthood was associated with longer operative time (+75.2 min, P < .001) and increased LOS (+1.3 days, P = .01).

CONCLUSIONS

Young adults undergoing PSF for NMS experience higher perioperative morbidity and resource utilization than adolescents, including longer operative times, increased risk of adverse events, and non-home discharge. These findings describe higher perioperative risk among young adults but should not be interpreted as demonstrating that delayed surgery itself causes worse outcomes.

KEY CONCEPTS: (1)Young adults undergoing posterior spinal fusion for neuromuscular scoliosis experience significantly greater perioperative morbidity than adolescents.(2)Surgery in young adulthood is independently associated with longer operative time, increased length of stay, and higher odds of allogeneic transfusion.(3)Young adults have more than double the adjusted risk of perioperative adverse events and non-home discharge than adolescents.

LEVEL OF EVIDENCE: III, Retrospective Cohort Study.