Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery

Oheneba Boachie-Adjei, Mitsuru Yagi, Cristina Sacramento-Dominguez, Harry Akoto, Matthew E. Cunningham, Munish Gupta, William F. Hess, Baron S. Lonner, Jennifer Ayamga, Elias Papadopoulus, Federico Sanchez-Perez-Grueso, Feran Pelise, Kenneth J. Paonessa, Han Jo Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Study design Retrospective review. Objective The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a preoperative classification that stratifies surgical risk and case difficulty. Summary of Background Data Pediatric spinal deformity (PSD) surgery can be challenging technically as well as economically. Often, a multidisciplinary approach to managing these patients is necessary. In an environment where resources are limited, such as in global outreach efforts, a method for stratifying PSD surgical cases can be useful for allocating appropriate resources and assigning appropriate skill sets in order to optimize patient outcomes and to streamline efforts. Materials and Methods A total of 145 consecutive PSD patients who underwent instrumented spinal fusion were reviewed. Radiographic measurements and demographic data were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the preoperative neurologic status, body mass index and type of osteotomies. Multiple regression analysis (MRA) and logistic regression analysis (LRA) were applied to indicate risk factors for complications. Results The average age was 14.3 years (10-20 years). The etiology was idiopathic scoliosis (n = 71), congenital scoliosis (n = 38), infectious (n = 11), and others. 23 patients had neurologic deficits preoperatively. Twenty-three patients had a posterior vertebral column resection. Patients were classified as Level 1 (n = 5), Level 2 (n = 19), Level 3 (n = 24), Level 4 (n = 58), and Level 5 (n = 39). Intraoperative neuro-monitoring changes were observed in 46 cases. Major complications were seen in 45 cases. A major complication consisted of implant related (n = 13), deep wound infection (n = 8), neurologic deficit (n = 7), death (n = 2), and others (n = 9). MRA demonstrated a significant correlation between classified level and %EBL/TBV, operative time, and complication rate. The risk level predicted the occurrence of general (odds ratio [OR] = 1.54; 95% confidence interval [CI] = 1.08-2.21; p =.019) and neurologic (OR = 3.34; 95% CI = 1.06-17.70; p =.036) complications. Osteotomy and resection procedures were independent predictors for postoperative neurologic complications (OR = 1.7, 95% CI = 1.11-2.85; p =.015). Conclusion Corrective spine surgery for complex pediatric deformity is challenging and carries a substantial risk. No single parameter appears to independently predict postoperative complications. However, when all risk factors are considered, there is a trend toward increased intraoperative electromonitoring change and postoperative neurologic risk with the higher level score in our classification. The newly established surgical risk stratification based on patient-specific clinical and radiographic factors can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal outcomes.

Original languageEnglish
Pages (from-to)340-349
Number of pages10
JournalSpine Deformity
Volume2
Issue number5
DOIs
Publication statusPublished - 2014

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Pediatrics
Nervous System
Spine
Odds Ratio
Regression Analysis
Scoliosis
Confidence Intervals
Osteotomy
Neurologic Manifestations
Intraoperative Monitoring
Spinal Fusion
Wound Infection
Operative Time
Body Mass Index
Retrospective Studies
Logistic Models
Demography

Keywords

  • Complication
  • Congenital scoliosis
  • Deformity
  • Idiopathic scoliosis
  • Scoliosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Boachie-Adjei, O., Yagi, M., Sacramento-Dominguez, C., Akoto, H., Cunningham, M. E., Gupta, M., ... Kim, H. J. (2014). Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery. Spine Deformity, 2(5), 340-349. https://doi.org/10.1016/j.jspd.2014.05.004

Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery. / Boachie-Adjei, Oheneba; Yagi, Mitsuru; Sacramento-Dominguez, Cristina; Akoto, Harry; Cunningham, Matthew E.; Gupta, Munish; Hess, William F.; Lonner, Baron S.; Ayamga, Jennifer; Papadopoulus, Elias; Sanchez-Perez-Grueso, Federico; Pelise, Feran; Paonessa, Kenneth J.; Kim, Han Jo.

In: Spine Deformity, Vol. 2, No. 5, 2014, p. 340-349.

Research output: Contribution to journalArticle

Boachie-Adjei, O, Yagi, M, Sacramento-Dominguez, C, Akoto, H, Cunningham, ME, Gupta, M, Hess, WF, Lonner, BS, Ayamga, J, Papadopoulus, E, Sanchez-Perez-Grueso, F, Pelise, F, Paonessa, KJ & Kim, HJ 2014, 'Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery', Spine Deformity, vol. 2, no. 5, pp. 340-349. https://doi.org/10.1016/j.jspd.2014.05.004
Boachie-Adjei, Oheneba ; Yagi, Mitsuru ; Sacramento-Dominguez, Cristina ; Akoto, Harry ; Cunningham, Matthew E. ; Gupta, Munish ; Hess, William F. ; Lonner, Baron S. ; Ayamga, Jennifer ; Papadopoulus, Elias ; Sanchez-Perez-Grueso, Federico ; Pelise, Feran ; Paonessa, Kenneth J. ; Kim, Han Jo. / Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery. In: Spine Deformity. 2014 ; Vol. 2, No. 5. pp. 340-349.
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abstract = "Study design Retrospective review. Objective The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a preoperative classification that stratifies surgical risk and case difficulty. Summary of Background Data Pediatric spinal deformity (PSD) surgery can be challenging technically as well as economically. Often, a multidisciplinary approach to managing these patients is necessary. In an environment where resources are limited, such as in global outreach efforts, a method for stratifying PSD surgical cases can be useful for allocating appropriate resources and assigning appropriate skill sets in order to optimize patient outcomes and to streamline efforts. Materials and Methods A total of 145 consecutive PSD patients who underwent instrumented spinal fusion were reviewed. Radiographic measurements and demographic data were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the preoperative neurologic status, body mass index and type of osteotomies. Multiple regression analysis (MRA) and logistic regression analysis (LRA) were applied to indicate risk factors for complications. Results The average age was 14.3 years (10-20 years). The etiology was idiopathic scoliosis (n = 71), congenital scoliosis (n = 38), infectious (n = 11), and others. 23 patients had neurologic deficits preoperatively. Twenty-three patients had a posterior vertebral column resection. Patients were classified as Level 1 (n = 5), Level 2 (n = 19), Level 3 (n = 24), Level 4 (n = 58), and Level 5 (n = 39). Intraoperative neuro-monitoring changes were observed in 46 cases. Major complications were seen in 45 cases. A major complication consisted of implant related (n = 13), deep wound infection (n = 8), neurologic deficit (n = 7), death (n = 2), and others (n = 9). MRA demonstrated a significant correlation between classified level and {\%}EBL/TBV, operative time, and complication rate. The risk level predicted the occurrence of general (odds ratio [OR] = 1.54; 95{\%} confidence interval [CI] = 1.08-2.21; p =.019) and neurologic (OR = 3.34; 95{\%} CI = 1.06-17.70; p =.036) complications. Osteotomy and resection procedures were independent predictors for postoperative neurologic complications (OR = 1.7, 95{\%} CI = 1.11-2.85; p =.015). Conclusion Corrective spine surgery for complex pediatric deformity is challenging and carries a substantial risk. No single parameter appears to independently predict postoperative complications. However, when all risk factors are considered, there is a trend toward increased intraoperative electromonitoring change and postoperative neurologic risk with the higher level score in our classification. The newly established surgical risk stratification based on patient-specific clinical and radiographic factors can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal outcomes.",
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author = "Oheneba Boachie-Adjei and Mitsuru Yagi and Cristina Sacramento-Dominguez and Harry Akoto and Cunningham, {Matthew E.} and Munish Gupta and Hess, {William F.} and Lonner, {Baron S.} and Jennifer Ayamga and Elias Papadopoulus and Federico Sanchez-Perez-Grueso and Feran Pelise and Paonessa, {Kenneth J.} and Kim, {Han Jo}",
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TY - JOUR

T1 - Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery

AU - Boachie-Adjei, Oheneba

AU - Yagi, Mitsuru

AU - Sacramento-Dominguez, Cristina

AU - Akoto, Harry

AU - Cunningham, Matthew E.

AU - Gupta, Munish

AU - Hess, William F.

AU - Lonner, Baron S.

AU - Ayamga, Jennifer

AU - Papadopoulus, Elias

AU - Sanchez-Perez-Grueso, Federico

AU - Pelise, Feran

AU - Paonessa, Kenneth J.

AU - Kim, Han Jo

PY - 2014

Y1 - 2014

N2 - Study design Retrospective review. Objective The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a preoperative classification that stratifies surgical risk and case difficulty. Summary of Background Data Pediatric spinal deformity (PSD) surgery can be challenging technically as well as economically. Often, a multidisciplinary approach to managing these patients is necessary. In an environment where resources are limited, such as in global outreach efforts, a method for stratifying PSD surgical cases can be useful for allocating appropriate resources and assigning appropriate skill sets in order to optimize patient outcomes and to streamline efforts. Materials and Methods A total of 145 consecutive PSD patients who underwent instrumented spinal fusion were reviewed. Radiographic measurements and demographic data were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the preoperative neurologic status, body mass index and type of osteotomies. Multiple regression analysis (MRA) and logistic regression analysis (LRA) were applied to indicate risk factors for complications. Results The average age was 14.3 years (10-20 years). The etiology was idiopathic scoliosis (n = 71), congenital scoliosis (n = 38), infectious (n = 11), and others. 23 patients had neurologic deficits preoperatively. Twenty-three patients had a posterior vertebral column resection. Patients were classified as Level 1 (n = 5), Level 2 (n = 19), Level 3 (n = 24), Level 4 (n = 58), and Level 5 (n = 39). Intraoperative neuro-monitoring changes were observed in 46 cases. Major complications were seen in 45 cases. A major complication consisted of implant related (n = 13), deep wound infection (n = 8), neurologic deficit (n = 7), death (n = 2), and others (n = 9). MRA demonstrated a significant correlation between classified level and %EBL/TBV, operative time, and complication rate. The risk level predicted the occurrence of general (odds ratio [OR] = 1.54; 95% confidence interval [CI] = 1.08-2.21; p =.019) and neurologic (OR = 3.34; 95% CI = 1.06-17.70; p =.036) complications. Osteotomy and resection procedures were independent predictors for postoperative neurologic complications (OR = 1.7, 95% CI = 1.11-2.85; p =.015). Conclusion Corrective spine surgery for complex pediatric deformity is challenging and carries a substantial risk. No single parameter appears to independently predict postoperative complications. However, when all risk factors are considered, there is a trend toward increased intraoperative electromonitoring change and postoperative neurologic risk with the higher level score in our classification. The newly established surgical risk stratification based on patient-specific clinical and radiographic factors can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal outcomes.

AB - Study design Retrospective review. Objective The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a preoperative classification that stratifies surgical risk and case difficulty. Summary of Background Data Pediatric spinal deformity (PSD) surgery can be challenging technically as well as economically. Often, a multidisciplinary approach to managing these patients is necessary. In an environment where resources are limited, such as in global outreach efforts, a method for stratifying PSD surgical cases can be useful for allocating appropriate resources and assigning appropriate skill sets in order to optimize patient outcomes and to streamline efforts. Materials and Methods A total of 145 consecutive PSD patients who underwent instrumented spinal fusion were reviewed. Radiographic measurements and demographic data were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the preoperative neurologic status, body mass index and type of osteotomies. Multiple regression analysis (MRA) and logistic regression analysis (LRA) were applied to indicate risk factors for complications. Results The average age was 14.3 years (10-20 years). The etiology was idiopathic scoliosis (n = 71), congenital scoliosis (n = 38), infectious (n = 11), and others. 23 patients had neurologic deficits preoperatively. Twenty-three patients had a posterior vertebral column resection. Patients were classified as Level 1 (n = 5), Level 2 (n = 19), Level 3 (n = 24), Level 4 (n = 58), and Level 5 (n = 39). Intraoperative neuro-monitoring changes were observed in 46 cases. Major complications were seen in 45 cases. A major complication consisted of implant related (n = 13), deep wound infection (n = 8), neurologic deficit (n = 7), death (n = 2), and others (n = 9). MRA demonstrated a significant correlation between classified level and %EBL/TBV, operative time, and complication rate. The risk level predicted the occurrence of general (odds ratio [OR] = 1.54; 95% confidence interval [CI] = 1.08-2.21; p =.019) and neurologic (OR = 3.34; 95% CI = 1.06-17.70; p =.036) complications. Osteotomy and resection procedures were independent predictors for postoperative neurologic complications (OR = 1.7, 95% CI = 1.11-2.85; p =.015). Conclusion Corrective spine surgery for complex pediatric deformity is challenging and carries a substantial risk. No single parameter appears to independently predict postoperative complications. However, when all risk factors are considered, there is a trend toward increased intraoperative electromonitoring change and postoperative neurologic risk with the higher level score in our classification. The newly established surgical risk stratification based on patient-specific clinical and radiographic factors can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal outcomes.

KW - Complication

KW - Congenital scoliosis

KW - Deformity

KW - Idiopathic scoliosis

KW - Scoliosis

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