Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective

Chirag G Patil, Justin Santarelli, Shivanand P Lad, Chris Ho, Wendy Tian, Maxwell Boakye
Spine Journal: Official Journal of the North American Spine Society 2008, 8 (6): 904-10

BACKGROUND CONTEXT: Information about complications and mortality after surgery for correction of idiopathic scoliosis has been largely derived from single-institution series. Regional or national studies have been lacking.

PURPOSE: To report inpatient mortality, complications, and discharge disposition after surgical correction of idiopathic scoliosis on a national level.

STUDY DESIGN: Retrospective cohort study using National Inpatient Sample (NIS) administrative data.

PATIENT SAMPLE: All patients in the NIS with the primary diagnosis of idiopathic scoliosis who underwent a spinal fusion between 1993 and 2002 were included.

OUTCOME MEASURES: Inpatient complication rate, mortality rate, and adverse outcome defined by death or discharge to institution other than home.

METHODS: Outcome measures were abstracted from the NIS. Univariate and multivariate analyses were performed to analyze the effects of patient and hospital characteristics on outcome measures.

RESULTS: The NIS was used to identify 51,911 patients who underwent spinal fusion for idiopathic scoliosis in the United States from 1993 to 2002. The total inhospital complication rate was 14.9% for pediatric patients and 25.1% for adult patients. The inhospital mortality rate was 0.17% and 0.40% for pediatric and adult patients, respectively. Adverse outcome was noted in 2.3% of pediatric patients and 20.4% of adult patients. Pulmonary and postoperative hemorrhages/hematomas were the most common complications reported. Multivariate analysis for complications showed that morbidity was significantly lower for pediatric patients (odds ratio [OR] = 0.80; confidence interval [CI] = 0.68-0.94) and female patients (OR = 0.77; CI = 0.68-0.88). Patients with a preoperative comorbidity were 1.53 (CI = 1.32-1.76) times more likely to develop a complication. A single postoperative complication increased the mean length of stay by more than 2 days and increased the mortality rate, adverse outcome, and hospital charges significantly.

CONCLUSIONS: We have provided a national perspective on inpatient complications, mortality, and discharge disposition after spinal fusion for idiopathic scoliosis in the United States. The significant negative effects of postoperative complications on mortality and resource utilization have been demonstrated. Furthermore, we have identified adult age, male gender, and preoperative comorbidity as important risk factors and defined their impact on patient outcomes.

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