Of Major Complication Types, Only Deep Infections After Spinal Fusion Are Associated With Worse Health-related Outcomes in Children With Cerebral Palsy. Issue 14 (15th July 2020)

• Record Type: Journal Article
• Authors: Eguia, Francisco; Nhan, Derek T.; Shah, Suken A.; Jain, Amit; Samdani, Amer F.; Yaszay, Burt; Pahys, Joshua M.; Marks, Michelle C.; Sponseller, Paul D.
• Is Part Of: Spine. Volume 45:Issue 14(2020)
• Publication Date: 2020-07-15
• Subjects: Caregiver priorities and child health index of life with disabilities -- cerebral palsy -- complications -- deep infection -- health-related quality of life -- long-term patient-reported outcomes -- scoliosis -- scoliosis surgery -- spinal arthrodesis -- spine deformity; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000003463
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective review. Objective: The aim of this study was to determine whether major postoperative complications ("complications") are associated with 2-year improvements in Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) scores after scoliosis surgery, and whether complications and preoperative characteristics predict 2-year improvements in CPCHILD Total score. Summary of Background Data: Spinal arthrodesis can halt the progression of spinal deformity in patients with cerebral palsy (CP)-related scoliosis. However, these patients are prone to postoperative complications. Methods: Using a multicenter CP registry, we identified 222 patients aged ⩽21 years who underwent spinal fusion from 2008 to 2015 and had ≥2-year follow-up. We compared CPCHILD score improvement between 71 patients who had 1 or more complications ("complications group") versus 151 who did not ("no-complications group"). Complications were deep infections, thromboembolic events, and cardiopulmonary, gastrointestinal, and neurologic complications. Multiple linear regression was used to identify predictors of 2-year postoperative CPCHILD score improvement (alpha = 0.05). Results: At 2-year follow-up, the complications group had similar mean improvement in CPCHILD score across all domains compared with the no-complications group ( P > 0.05). When stratifying by complication type, deep infection was associated with less improvement in CPCHILD Comfort and Emotions ( P = 0.02), Quality of Life ( P < 0.01), and Total ( P = 0.04) scores. When controlling for Gross Motor Function Classification System subcategory, age, and body mass index, only preoperative CPCHILD Total score and postoperative deep infection (F[4, 176] = 14; P < 0.0001; R 2 = 0.24) predicted 2-year improvement in CPCHILD Total score. Higher preoperative Total score and postoperative deep infection independently predicted less improvement in Total score. Conclusion: Postoperative deep infection and higher preoperative CPCHILD Total score independently predicted less improvement in CPCHILD Total score. Other major postoperative complications were not associated with differences in 2-year postoperative improvements in CPCHILD scores across all domains. Level of Evidence: 3 Abstract : We investigated the association between postoperative major complications and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) total score in 222 pediatric cerebral palsy scoliosis patients 2 years post-PSF. Patients with higher preoperative scores and those with postoperative deep infections had less CPCHILD total score improvement than patients with lower preoperative scores and those without postoperative deep infections.