Length of stay, readmission, and mortality after primary surgery for pediatric spinal deformities: a 10-year nationwide cohort study

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  • Sidsel Fruergaard, Københavns Universitet
  • ,
  • Søren Ohrt-Nissen, Københavns Universitet
  • ,
  • Frederik Taylor Pitter, Københavns Universitet
  • ,
  • Kristian Høy
  • Martin Lindberg-Larsen, Syddansk Universitet
  • ,
  • Søren Eiskjær, Aalborg Universitet
  • ,
  • Benny Dahl, Texas Children's Hospital and Baylor College of Medicine
  • ,
  • Martin Gehrchen, Københavns Universitet

BACKGROUND CONTEXT: Extended length of stay (extLOS) and unplanned readmissions after first time pediatric spinal deformity surgery are a considerable challenge to both the patient and the health-care system. To our knowledge, only a limited number of nationwide studies reporting short-term comorbidity with complete follow-up exist.

PURPOSE: The purpose of this study was to identify the postoperative complications leading to extLOS, readmissions, and mortality within 90 days after surgery. Furthermore, to identify risk factors for readmission.

DESIGN: Retrospective national cohort study.

PATIENT SAMPLE: A nationwide registry study including all pediatric spinal deformity patients (

OUTCOME MEASURES: Reasons for extLOS and 90-day readmissions as well as mortality risk.

METHODS: Patients were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on length of stay (LOS), readmissions, and mortality within 90 days were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Reasons for extLOS and readmission were collected from medical records and discharge summaries.

RESULTS: For the 1,310 patients, the median LOS was 8 days (interquartile range 7-9). Etiologies were idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann kyphosis (5%), and syndromic deformity (3%). A total of 274 (21%) patients had extLOS and the most common reason was pain/mobilization issues but with considerable variation between etiologies; Scheuermann kyphosis (91%), idiopathic (59%), syndromic (44%), spondylolisthesis (38%), and congenital (30%). Pulmonary complications were the primary reason for extLOS in the neuromuscular group (22%). The 90-day readmission rate was 6%; 67% of readmissions were medical, mainly infections unrelated to the surgical site (23%); 33% of readmissions were surgical and 14% of patients required revision surgery. Neuromuscular deformity, spondylolisthesis, Scheuermann kyphosis, and LOS > 9 days were independent risk factors for readmission; odds ratio (OR) 4.4 (95% confidence interval: 2.2-9.1, p

CONCLUSIONS: In this nationwide cohort, pain/mobilization issues are the most common reason for extLOS. The most common reason for readmission is infection unrelated to the surgical site. Readmission after pediatric spinal surgery is related to the etiology and increased focus on patients operated for neuromuscular deformity, spondylolisthesis and Scheuermann kyphosis is warranted. (C) 2021 Elsevier Inc. All rights reserved.

OriginalsprogEngelsk
TidsskriftThe Spine Journal
Vol/bind21
Nummer4
Sider (fra-til)653-663
Antal sider11
ISSN1529-9430
DOI
StatusUdgivet - apr. 2021

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