66. The morbidity, readmissions, and cost for pediatric cerebral palsy patients undergoing primary spinal fusion surgery: a national analysis of 2,779 patients

Abstract

BACKGROUND CONTEXT Complications following spinal deformity surgery in pediatric patients with cerebral palsy are known to be significant and costly. Prior single-surgeon data suggests the unplanned 90-day readmission rate for this population to be 16.1%. Reducing unplanned readmission and avoidable complications is a priority for spine surgeons. The readmission risk profile for pediatric cerebral palsy (CP) patients after spine surgery has yet to be defined on a national level. PURPOSE To examine the underlying reasons for readmissions in this population as well as provide national estimates for perioperative morbidity and cost. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Pediatric CP patients undergoing spinal fusion surgery. OUTCOME MEASURES 90-day readmissions, complications, and outcomes. METHODS A large multicentered 4-year database was queried for pediatric patients (age≤19) diagnosed with CP and who underwent spinal fusion surgery. Patient, hospital, and cost data were assessed in the bivariate analyses. Independent risk factors for readmissions were identified using step-wise multivariate logistic regression. RESULTS A total of 2,779 pediatric patients with CP (47.5% female) underwent spinal fusion surgery between 2012 and 2015. Of the 2,779 patients, 461 (16.6%) were readmitted within 90 days following the primary surgery. The mean hospital cost associated with the primary admission was $211,057 (no readmission) and $260,173 (readmission). The top index inpatient complications included respiratory issues (no readmission vs readmission, p-value: 11.0% vs 20.1%, CONCLUSIONS The national readmission rate for pediatric CP undergoing spine deformity surgery is high (16.6%). History of renal failure was the strongest risk factor for readmission (OR 38.6). Pulmonary, wound complication, and implant-related issues, which all may be potentially avoidable, make up nearly 50% of reasons for unplanned readmissions. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.