Hospital Burdens of Patients With Cerebral Palsy Undergoing Posterior Spinal Fusion for Scoliosis

• Authors: Albert T Anastasio, Duke University; Ndeye F Guisse, Emory University; Kevin X Farley, Emory University; John Rhee, Emory University
• Journal Title: GLOBAL SPINE JOURNAL
• Volume: Volume 12, Number 5
• Publisher: SAGE PUBLICATIONS LTD | 2020-11-18, Pages 883-889
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/2192568220968542
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Orthopedics; Neurosciences & Neurology; cerebral palsy; cost; spinal fusion; pediatric; complication; scoliosis; burden; SURGICAL SITE INFECTION; NEUROMUSCULAR SCOLIOSIS; RISK-FACTORS; DISCRIMINATIVE ABILITY; COMORBIDITY MEASURE; ADVERSE OUTCOMES; INPATIENT-SAMPLE; REDUCTION; CHILDREN; SURGERY

Abstract

Study Design: Retrospective cohort study. Objectives: Many patients undergoing posterior spinal fusion (PSF) for scoliosis have concurrent cerebral palsy (CP), which is associated with many medical comorbidities and inherent operative risk. We aimed to quantify the contribution of CP to increased cost, length of stay (LOS), and complication rates in patients with scoliosis undergoing PSF. Methods: Using the National Inpatient Sample database, we collected data regarding patient demographics, hospital characteristics, comorbidities, in-hospital complications, and mortality. Primary outcomes included complications, hospital LOS, and total hospital costs. Multivariate regression models assessed the contribution of CP to in-hospital complications, discharge status, and mortality. Linear regression identified the contribution of a diagnosis of CP on hospital LOS and inflation-adjusted cost. Results: Cerebral palsy was an independent predictor of several complications. The most striking differences were seen for mortality (odds ratio [OR]: 3.40, P <.001), a postoperative requirement for total parenteral nutrition (OR: 3.16, P <.001), urinary tract infection (OR: 2.75, P <.001), surgical site infection (OR: 2.67, P <.001), and pneumonia (2.21, P <.001). Patients with CP ultimately cost an additional $13 482 (P <.001) with a 2.07-day greater LOS (P <.001) than patients without CP. Conclusion: Most complications were seen in higher rates in the CP cohort, with higher cost and LOS in patients with CP versus those with idiopathic scoliosis (IS). Our findings represent important areas of emphasis during preoperative consultations with patients with CP and their families. Extra care in patient selection and multifaceted treatment protocols should continue to be implemented with further investigation on how to mitigate common complications.