Oral Posters: Values and Outcomes in Spine Surgery

Presented by: P. Zhou - View Audio/Video Presentation (Members Only)

Author(s):

B. Diebo(1), A. Patel(1), C. Paulino(1), G. Poorman(2), J. Varghese(3), R. Lafage(3), C. Jalai(2), S. Horn(2), P. Zhou(2), V. Lafage(3), F. Schwab(3), T. Errico(2), Q. Naziri(1), P. Passias(2)

(1) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(2) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
(3) Hospital for Special Surgery, Spine Service, New York, NY, United States

Abstract

Introduction: DIC is a life-threatening complication of pediatric scoliosis surgery characterized by activation of the clotting cascade; however, its occurrence and impact have been studied sparsely.

Hypothesis: DIC after spinal fusion for scoliosis is rare, but not random complication.

Study Design/Setting: Retrospective cohort analysis of the Kid's Inpatient Database (KID).

Method: DIC incidence was first compared between three groups: scoliosis patients undergoing fusion (pts), open reduction of a fracture with internal fixation (ORIF), and general pts´ population of KID (Gen). Pts aged 0-20 with ICD-9 diagnoses of idiopathic or congenital scoliosis, who underwent spinal fusion in 2000, 2003, 2006, or 2009 were included in the analysis. Demographics, comorbidities, complications, and surgical metrics were compared between pts who developed DIC vs. not. Binary logistic regression based on significant variables determined independent predictors of DIC.

Results: DIC incidence was higher following scoliosis surgery compared to ORIF and Gen (0.3% vs. 0.06% vs. 0.04%, p=0.001). DIC incidence was similar across years studied. 32, 909 scoliosis pts who underwent surgery were grouped by DIC presence: DIC: n=84, no-DIC: n=32825. Groups had similar demographics (13.7 yr, 59-67% F) with higher % of obese pts in DIC (4.8% vs. 1.5%, p< 0.01) and worse Charlson score (1.75 vs. 0.62, p=0.001). DIC had similar surgical invasiveness, scoliosis types and primary vs. revision cases. Regressions identified significant DIC predictors: Charlson score (OR 1.8 [1.6-2.0]), skin rash/eruption (OR 9.5 [3.2-28.2]), and Barth, Smith-Lemli-Opitz and Alport syndromes (OR 3.5 [1.2-10.2]), all p< 0.001. Most common surgical complication associated with DIC was reaction to ortho/neuro device (OR 7.9 [2.9-21.9]). 47.6% of DIC had transfusion of packed red cell, and 4.8% had coagulation factors. Pre-discharge, DIC had higher rates of infection (12 vs. 4.8% mainly mycobacterium), pneumothorax (4.8% vs. 1.7%), septicemia (6 vs. 0.5%), carditis (16.9% vs. 2%), cardiac arrest (3.6 vs. 0.2%), and shock (8.3 vs. 0.1%), all p< 0.001. 50% of DIC had prolonged intubation and 14.5% had respiratory failure. DIC had longer length of stay (16.1 vs. 6.7 days), higher hospital charges ($176, 311 vs. $103, 472), and higher mortality rate (6% vs. 0.2%), all p< 0.01.

Conclusion: DIC following spinal fusion for scoliosis is a rare condition with a prevalence of 0.3% and mortality rate of 6%. This study raised awareness toward this life threatening condition. Factors associated with DIC were proposed and warrant further investigations.