How Do Complications Within the First 30 days after Spinal Deformity Surgery in Children with Cerebral Palsy Affect Length of Stay?

Study Design: Retrospective cohort. Objective: To provide a national-level assessment of the short-term outcomes after spinal deformity surgery in pediatric patients with cerebral palsy. Methods: A national, prospectively collected database was queried to identify pediatric (≤18 years) patients with cerebral palsy, who underwent spinal fusion surgery from 2012 to 2017. Separate multivariate analyses were performed for the primary outcomes of interest including extended length of stay (>75th percentile, >8 days), and readmissions within 90 days after the index admission. Results: A total of 2856 patients were reviewed. The mean age ± standard deviation was 12.8 ± 2.9 years, and 49.4% of patients were female. The majority of patients underwent a posterior spinal fusion (97.0%) involving ≥8 levels (79.9%) at a teaching hospital (96.6%). Top medical complications (24.5%) included acute respiratory failure requiring mechanical ventilation (11.4%), paralytic ileus (8.2%), and urinary tract infections (4.6%). Top surgical complications (40.7%) included blood transfusion (35.6%), wound complication (4.9%), and mechanical complication (2.7%). The hospital cost for patients with a length of hospital stay >8 days ($113 669) was nearly double than that of those with a shorter length of stay ($68 411). The 90-day readmission rate was 17.6% (mean days to readmission: 30.2). The most common reason for readmission included wound dehiscence (21.1%), surgical site infection (19.1%), other infection (18.9%), dehydration (16.9%), feeding issues (14.5%), and acute respiratory failure (13.1%). Notable independent predictors for 90-day readmissions included preexisting pulmonary disease (odds ratio [OR] 1.5), obesity (OR 3.4), cachexia (OR 27), nonteaching hospital (OR 3.5), inpatient return to operating room (OR 1.9), and length of stay >8 days (OR 1.5). Conclusions: Efforts focused on optimizing the perioperative pulmonary, hematological, and nutritional status as well as reducing wound complications appear to be the most important for improving clinical outcomes.

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Surgical Correction of Spinal Deformity Using a Unit Rodin Children with Cerebral Palsy

Journal of Pediatric Orthopaedics ◽

10.1097/00004694-199611000-00007 ◽

1996 ◽

pp. 734-740 ◽

Cited By ~ 1

Author(s):

Rita Cardoso Dias ◽

Freeman Miller ◽

Kirk Dabney ◽

Glenn Lipton ◽

Thomas Temple

Keyword(s):

Cerebral Palsy ◽

Spinal Deformity ◽

Surgical Correction ◽

Children With Cerebral Palsy

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Reduction of Deep Infections and Length of Stay in Paediatric Spinal Deformity Surgery After the Introduction of A Standardised Care Pathway

International Journal of Orthopaedics ◽

10.17554/j.issn.2311-5106.2018.05.263 ◽

2018 ◽

Vol 5 (3) ◽

pp. 916-920

Author(s):

Diana Claire Lavelle ◽

◽

Ian James Harding ◽

John Mervyn Hutchinson ◽

Michael Katsimihas ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Deformity ◽

Care Pathway ◽

Spinal Deformity Surgery

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313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly

The Spine Journal ◽

10.1016/j.spinee.2019.05.330 ◽

2019 ◽

Vol 19 (9) ◽

pp. S152

Author(s):

Paramjit Singh ◽

John Ibrahim ◽

Deeptee Jain ◽

Paul Eichenseer ◽

Mayur Kardile ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

The Elderly ◽

Spinal Deformity Surgery ◽

Surgery In The Elderly

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Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity

Neurosurgery ◽

10.1093/neuros/nyx218 ◽

2017 ◽

Vol 82 (3) ◽

pp. 378-387 ◽

Cited By ~ 28

Author(s):

Corinna C Zygourakis ◽

Caterina Y Liu ◽

Malla Keefe ◽

Christopher Moriates ◽

John Ratliff ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Severity Of Illness ◽

Total Hospital Cost ◽

Median Income ◽

Cost Variation ◽

Time Period ◽

Spinal Deformity Surgery ◽

The Mean

Abstract BACKGROUND Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity. OBJECTIVE To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery. METHODS The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses. RESULTS The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05). CONCLUSION The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.

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