Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study

Objective.To identify risk factors associated with surgical site infection (SSI) after pediatric posterior spinal fusion procedure by examining characteristics related to the patient, the surgical procedure, and tissue hypoxia.Design.Retrospective case-control study nested in a hospital cohort study.Setting.A 475-bed, tertiary care children's hospital.Methods.All patients who underwent a spinal fusion procedure during the period from January 1995 through December 2006 were included. SSI cases were identified by means of prospective surveillance using National Nosocomial Infection Surveillance system definitions. Forty-four case patients who underwent a posterior spinal fusion procedure and developed an SSI were identified and evaluated. Each case patient was matched (on the basis of date of surgery, ± 3 months) to 3 control patients who underwent a posterior spinal fusion procedure but did not develop an SSI. Risk factors for SSI were evaluated by univariate analysis and multivariable conditional logistic regression. Odds ratios (ORs), with 95% confidence intervals (CIs) andPvalues, were calculated.Results.From 1995 to 2006, the mean annual rate of SSI after posterior spinal fusion procedure was 4.4% (range, 1.1%—6.7%). Significant risk factors associated with SSI in the univariate analysis included the following: a body mass index (BMI) greater than the 95th percentile (OR, 3.5 [95% CI, 1.5–8.3]); antibiotic prophylaxis with clindamycin, compared with other antibiotics (OR, 3.5 [95% CI, 1.2 10.0]); inappropriately low dose of antibiotic (OR, 2.6 [95% CI, 1.0–6.6]); and a longer duration of hypothermia (ie, a core body temperature of less than 35.5°C) during surgery (OR, 0.4 [95% CI, 0.2–0.9]). An American Society of Anesthesiologists (ASA) score of greater than 2, obesity (ie, a BMI greater than the 95th percentile), antibiotic prophylaxis with clindamycin, and hypothermia were statistically significant in the multivariable model.Conclusion.An ASA score greater than 2, obesity, and antibiotic prophylaxis with clindamycin were independent risk factors for SSI. Hypothermia during surgery appears to provide protection against SSI in this patient population.

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Hidden Blood Loss in Adolescent Idiopathic Scoliosis Patients Undergoing Posterior Spinal Fusion Surgery: A Retrospective Study of 765 Cases in a Single Center

10.21203/rs.3.rs-523705/v1 ◽

2021 ◽

Author(s):

Lipeng Wang ◽

Jiangli Liu ◽

Xiaoxiao Song ◽

Muhui Luo ◽

Yongquan Chen

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Adolescent Idiopathic Scoliosis ◽

Blood Transfusion ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Postoperative Blood Transfusion ◽

Independent Risk Factors

Abstract Purpose: To investigate Hidden blood loss (HBL) and its potential risk factors in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery and elucidate the influence of HBL on postoperative blood transfusion. Methods: We retrospectively studied 765 patients undergoing posterior spine fusion for adolescent idiopathic scoliosis from January 2014 to December 2018. The patient’s demographics, blood loss related parameters, operation and blood loss information were extracted. The association between patient’s characteristics and HBL was analyzed by Pearson or Spearman correlation analysis. Multivariate linear regression analysis was used to determine independent risk factors associated with HBL. Binary logistic regression analysis was used to analyze the influence of HBL on postoperative blood transfusion.Results: A total of 765 patients including 128 males and 637 females (age range 10-18 years) were included in this study. The mean amount of HBL was 693.5±473.4 ml, accounting for 53.9% of the total blood loss. In multivariate linear regression analysis, we found that preoperative Hct (p=0.003) and allogeneic blood transfusion (p<0.0001) were independent risk factors for HBL, while tranexamic acid (p=0.003) was negatively related to HBL. Binary logistic regression analysis showed that HBL > 850 ml ( P < 0.001, OR: 8.845, 95%CI: 5.806-13.290) was the independent risk factor for postoperative blood transfusion.Conclusion: a large amount of HBL was incurred in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgeries. Allogeneic blood transfusion and preoperative Hct were independent risk factors for HBL, while tranexamic acid was negatively related to HBL. HBL and its influential factors should be taken into account when considering the perioperative transfusion management. These patients with HBL greater than 850 ml should be paid more attention in case of postoperative anemia.Level of evidence: Level III

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Screw Loosening in Posterior Spine Fusion: Prevalence and Risk Factors

Global Spine Journal ◽

10.1177/2192568219864341 ◽

2019 ◽

Vol 10 (5) ◽

pp. 598-602

Author(s):

Laura Marie-Hardy ◽

Hugues Pascal-Moussellard ◽

Anne Barnaba ◽

Raphael Bonaccorsi ◽

Caroline Scemama

Keyword(s):

Risk Factors ◽

Spinal Fusion ◽

Demographic Data ◽

Significant Risk ◽

Posterior Spinal Fusion ◽

Sagittal Imbalance ◽

Screw Loosening ◽

Logistic Regression Models ◽

Pull Out ◽

American Society

Study Design: Retrospective cohort study. Objective: Screw loosening in spinal fusion is poorly defined. Accordingly, its prevalence rates range from 1% to 60%, and its risk factors remain undefined. The goal of this study was to assess the prevalence of screw loosening, according to precise definitions, and to identify factors associated with it. Methods: We retrospectively reviewed records for 166 patients who underwent a posterior spinal fusion in our institution between 2011 and 2016. We recorded demographic data, osteoporosis, pelvic balance, surgery-related information, and postoperative radiographic data at a minimum follow-up of 6 months. Univariable and multivariable logistic regression models were used. Significance was defined by P < .05. Results: When loosening was defined by partial pull-out, its prevalence was 9.6% (95% CI 5.6-15); thoracic localization, the use of CrCo (chromium-cobalt) rods, osteoporosis, PI/LL (pelvic incidence/lumbar lordosis) mismatch (preoperative), and frontal imbalance (preoperative) were significant risk factors. When loosening was defined by osteolysis (radiolucent rim) >1 mm around at least 1 screw, its prevalence was 40.4% (95% CI 33-48) and age, scoliosis as indication for fusion, ASA (American Society of Anesthesiologists) 2 or 3, the use of CrCo rods, more than 5 levels fused, no circumferential arthrodesis, postoperative bracing, and sacrum or ilium as the inferior level of instrumentation were also significant risk factors. Conclusions: A clear definition of screw loosening seems essential for a useful analysis of the literature. Osteoporosis, sagittal imbalance, and rigid material appear to be risk factors, regardless of the definition.

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Adult degenerative scoliosis: evaluation and management

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09271 ◽

2010 ◽

Vol 28 (3) ◽

pp. E1 ◽

Cited By ~ 148

Author(s):

Fernando E. Silva ◽

Lawrence G. Lenke

Keyword(s):

Spinal Fusion ◽

Mechanical Stability ◽

Treatment Options ◽

Posterior Spinal Fusion ◽

Clinical Analysis ◽

Complication Rates ◽

Degenerative Scoliosis ◽

Anterior Spinal Fusion ◽

Adult Degenerative Scoliosis

Degenerative scoliosis is a prevalent issue among the aging population. Controversy remains over the role of surgical intervention in patients with this disease. The authors discuss a suitable approach to help guide surgical treatment, including decompression, instrumented posterior spinal fusion, anterior spinal fusion, and osteotomy. These treatment options are based on clinical analysis, radiographic analysis of the mechanical stability of the deformity, given pain generators, and necessary sagittal balance. The high potential complication rates appear to be outweighed by the eventual successful clinical outcomes in patients suitable for operative intervention. This approach has had favorable outcomes and could help resolve the controversy.

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Risk Factors for the Development of Delayed Infections Following Posterior Spinal Fusion and Instrumentation in Adolescent Idiopathic Scoliosis Patients

Spine ◽

10.1097/brs.0b013e31814b1c0b ◽

2007 ◽

Vol 32 (20) ◽

pp. 2272-2277 ◽

Cited By ~ 96

Author(s):

Christine Ho ◽

Daniel J. Sucato ◽

B Stephens Richards

Keyword(s):

Risk Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion

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Risk factors associated with prolonged intensive care unit stay after posterior spinal fusion for Duchenne muscular dystrophy

Journal of Orthopaedic Science ◽

10.1016/j.jos.2020.03.014 ◽

2020 ◽

Author(s):

Wataru Saito ◽

Gen Inoue ◽

Eiki Shirasawa ◽

Takayuki Imura ◽

Toshiyuki Nakazawa ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Spinal Fusion ◽

Intensive Care Unit Stay ◽

Posterior Spinal Fusion ◽

Factors Associated

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Orthostatic Hypotension Following Posterior Spinal Fusion Surgeries for Spinal Deformity Correction in Adolescents: Prevalence and Risk Factors

10.21203/rs.3.rs-618724/v1 ◽

2021 ◽

Author(s):

Ying Yang ◽

Yaping Chen ◽

Bingdu Tong ◽

Xue Tian ◽

Chunjie Yu ◽

...

Keyword(s):

Risk Factors ◽

Orthostatic Hypotension ◽

Hospital Stay ◽

Spinal Fusion ◽

Spinal Deformity ◽

Case Series ◽

Deformity Correction ◽

Length Of Hospital Stay ◽

Posterior Spinal Fusion ◽

Lower Limbs

Abstract Study Design: Retrospective case series.Objectives: This study aimed to determine the prevalence and risk factors for orthostatic hypotension (OH) in adolescents undergoing posterior spinal fusion for spinal deformity correction.Methods: The data of 312 consecutive adolescents who underwent posterior spinal fusion for spinal deformity correction in our center over 12 months were retrieved. Patient characteristics, including whether laminectomy or osteotomy was performed during the surgery, the occurrence of postoperative nausea and vomiting (PONV), perioperative hemoglobin albumin changes, perioperative blood transfusion, length of bed rest, willingness to ambulate, length of postoperative exercises of the lower limbs, and length of hospital stay, were collected and compared statistically between patients who did and did not develop postoperative OH.Results: Of 312 patients, 225 (72.1%) developed OH postoperatively, and all cases completely resolved 5 days after the first out-of-bed exercises. Significant differences in BMI, the incidence of PONV, the willingness to ambulate and the length of postoperative exercises of the lower limbs were observed. The mean length of hospital stay of the patients with OH was longer than that of the patients without OH.Conclusion: Our study suggests that temporary OH is a common manifestation following posterior spinal fusion for spinal deformity correction in adolescents. Postoperative OH may increase the length of hospital stay in these patients. Patients with PONV, who are not willing to ambulate and who perform postoperative lower limb exercises for a shorter time are more likely to have OH.

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