Perioperative Complications and Health-Related Quality of Life Outcomes in Severe Pediatric Spinal Deformity
Munish C Gupta 1, Lawrence G Lenke 2, Sachin Gupta 3, Ali S Farooqi 3, Jahangir K Asghar 4, Oheneba Boachie-Adjei 5, Patrick J Cahill 6, Mark A Erickson 7, Sumeet Garg 7, Peter O Newton 8, Amer F Samdani 9, Suken A Shah 10, Harry L Shufflebarger 11, Paul D Sponseller 12, Daniel J Sucato 13, David B Bumpass 14, Richard E McCarthy 14, Burt Yaszay 15, Joshua M Pahys 9, Jichao Ye 16, Michael P Kelly 1; Fox Pediatric Spinal Deformity Study Group
PMID: 37134134 DOI: 10.1097/BRS.0000000000004696
Study design: Prospective multicenter cohort study.
Objective: To evaluate perioperative complications and mid-term outcomes for severe pediatric spinal deformity.
Summary of background data: Few studies have evaluated the impact of complications on health-related quality of life (HRQoL) outcomes in severe pediatric spinal deformity.
Methods: Patients from a prospective, multicenter database with severe pediatric spinal deformity (minimum of 100° curve in any plane or planned vertebral column resection (VCR)) with a minimum of 2-years follow-up were evaluated (n=231). SRS-22r scores were collected preoperatively and at 2-years postoperatively. Complications were categorized as intraoperative, early postoperative (within 90-days of surgery), major, or minor. Perioperative complication rate was evaluated between patients with and without VCR. Additionally, SRS-22r scores were compared between patients with and without complications.
Results: Perioperative complications occurred in 135 (58%) patients, and major complications occurred in 53 (23%) patients. Patients that underwent VCR had a higher incidence of early postoperative complications than patients without VCR (28.9% vs. 16.2%, P =0.02). Complications resolved in 126/135 (93.3%) patients with a mean time to resolution of 91.63 days. Unresolved major complications included motor deficit (n=4), spinal cord deficit (n=1), nerve root deficit (n=1), compartment syndrome (n=1), and motor weakness due to recurrent intradural tumor (n=1). Patients with complications, major complications, or multiple complications had equivalent postoperative SRS-22r scores. Patients with motor deficits had lower postoperative satisfaction subscore (4.32 vs. 4.51, P =0.03), but patients with resolved motor deficits had equivalent postoperative scores in all domains. Patients with unresolved complications had lower postoperative satisfaction subscore (3.94 vs. 4.47, P =0.03) and less postoperative improvement in self-image subscore (0.64 vs. 1.42, P =0.03) as compared to patients with resolved complications.
Conclusion: Most perioperative complications for severe pediatric spinal deformity resolve within 2-years postoperatively and do not result in adverse HRQoL outcomes. However, patients with unresolved complications have decreased HRQoL outcomes.
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Conflict of interest statement
Conflict of Interest: None