Complication rates vary after paediatric surgery

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“There is considerable variation in complication rates based on the diagnosis and procedure for paediatric patients undergoing spine surgery,” Kai-Ming Fu, University of Virginia, Charlottesville, told delegates at the North American Spine Society’s annual meeting in Orlando, USA.

In a presentation titled “Morbidity and mortality associated with the operative treatment of disorders of the paediatric spine: A report from the Scoliosis Research Society Morbidity and Mortality committee” he explained that the database analysis set out to assess the morbidity and mortality rates associated with surgical treatment of paediatric spinal disorders based on a large, modern multicentre series.

 

“The mortality rates for all indicators were relatively low, but highest for kyphosis and trauma. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications, including new neurological deficits.”

 

The study has subsequently been published in the January 2011 issue of Journal of Neurosurgery. In the journal, authors write that the overall complication rate was 8.5%. Major complications included wound infections, new neurological deficits, implant-related complications, and haematomas.

 

In the presentation at the North American Spine Society, Fu noted that: “All surgical procedures carry inherent risks of complications. Complication rates are important for patient counselling, quality improvement, and medico-legal issues. Presently, there are very few studies regarding morbidity and mortality associated with operative treatment of spinal disorders in children which are available to guide the surgeon.

 

“Few modern series have documented complication rates for spine procedures in paediatric patients; most are based on relatively small series or single surgeon experience,” he said.

 

He explained that the Scoliosis Research Society has collected surgical case data from members since the 1960s. Members are predominantly fellowship trained spine surgeons, both orthopaedic and neurological. Parameters collected include morbidity and mortality, and all the data are de-identified.

 

Methods

 

The Scoliosis Research Society morbidity and mortality database was queried for the years 2004–2007. Patients who were less than 18 years old were identified for inclusion in the study.

 

The investigators categorised cases by operation type and diagnosis. All diagnoses were included: trauma, kyphosis, spondylolisthesis, scoliosis and others such as tumour and infection.

 

Details on the surgical approach, use of neurophysiological monitoring, and type of instrumentation were recorded. Major peri-operative complications and deaths were evaluated. Statistical analysis was performed with chi-square testing, with a p value <0.05 considered significant.

 

Results

 

The published article in the Journal of Neurosurgery reveals that investigators analysed data from a total of 23,918 patients who were included. The mean age was 13 ± 3.6 years (± SD). Spinal pathology included the following: scoliosis (19,642 patients), kyphosis (1,455), spondylolisthesis (748), trauma (478), and other (1,595 patients).

 

The overall complication rate was 8.5%. Major complications included wound infections (2.7%), new neurological deficits (1.4%), implant-related complications (1.6%), and haematomas (0.4%).

 

The most common medical complications were respiratory related (0.9%). Morbidity rates differed based on pathology, with patients undergoing treatment for kyphosis and spondylolisthesis having higher overall rates of morbidity (14.7% and 9.6%, respectively).

 

The authors wrote in the study that patients undergoing revision procedures (2,034) or corrective osteotomies (2,787) were more likely to suffer a complication or new neurological deficit. The majority of these deficits improved at least partially.

 

“Mortality rates for all indications and operations were low. Patients undergoing more aggressive corrective procedures for deformity are more likely to suffer complications and new neurological deficits,” said Fu.

 

Limitations

 

“Although data were collected prospectively, analysis and study design were performed retrospectively. The database was primarily designed to capture surgical complications and major medical complications and currently, there is no method to assess the completeness of data submission. Also, pseudoarthrosis was not a complication that was a specific category in the database,” noted Fu.

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