Risk factors of postoperative pulmonary complications after primary posterior fusion and hemivertebra resection in congenital scoliosis patients younger than 10 years old: a retrospective study

Lulu Ma,Yu Zhao,Jianguo Zhang,Yuguang Huang,Shugang Li,Jianxiong Shen,Xuerong Yu

doi:10.1186/s12891-022-05033-1

Abstract

BackgroundPostoperative pulmonary complications are common and associated with morbidity and mortality. Congenital scoliosis is a failure of vertebral formation and/or segmentation arising from abnormal vertebral development. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. The incidence of postoperative pulmonary complications in this specific group of patients, especially young children were unknown.MethodsA retrospective study was conducted and electronic medical records of early-onset scoliosis patients who had primary posterior fusion and hemivertebra resection at our institution from January 2014 to September 2019 were reviewed. The demographic characteristics, the intraoperative and postoperative parameters were collected to identify the predictors of postoperative pulmonary complications.ResultsA total of 174 patients (57.5% boys) with a median age of 3 years old were included for analysis. Eighteen patients (10.3%) developed perioperative pulmonary complications and pneumonia (n=13) was the most common. History of recent upper respiratory infection was not related to postoperative pulmonary complications. Multifactorial regression analysis showed thoracoplasty was the only predictive risk factor of postoperative pulmonary complications.ConclusionsFor congenital scoliosis patients younger than 10 years old, thoracoplasty determine the occurrence of postoperative pulmonary complications. Both surgeons and anesthesiologists should pay attention to patients undergoing thoracoplasty and preventive measures are necessary.

Highlights

Postoperative pulmonary complications are common and associated with morbidity and mortality
Congenital scoliosis is a failure of vertebral formation and / or segmentation arising from abnormal vertebral development
The progression of scoliosis is responsible for the deformity of rib cage and deterioration of pulmonary function

Summary

Introduction

Postoperative pulmonary complications are common and associated with morbidity and mortality. Posterior fusion and osteotomy are necessary for these patients to prevent deterioration of spine deformity. Postoperative pulmonary complications (PPC) are common and associated with morbidity, mortality, Intensive Care Unit (ICU) admission and higher costs [1, 2]. The progression of scoliosis is responsible for the deformity of rib cage and deterioration of pulmonary function. Previous reports had demonstrated that large Cobb angles [8, 9], long operation times [8], blood transfusion [8], thoracoplasty [10] and decreased forced vital capacity and forced expiratory volume in one second [9] were risks factors for PPC after scoliosis surgery. Age has been confirmed as the risk factor for respiratory critical events, with 12% decrease for each increasing year of age [11]

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