Towards a Definition of Physiologic Vulnerability in Pediatric Spine Surgery: Identification of Key Risk Factors in a Cohort Study of Children With Neuromuscular Disease Undergoing Spinal Fusion.

Abstract

Study DesignRetrospective cohort study.ObjectivesPreoperative risk stratification using frailty is common for adults but difficult to apply to pediatric populations. We aimed to identify risk factors indicating physiologic vulnerability and predict perioperative complications in children with neuromuscular scoliosis (NMS) and to create a prediction model for physiological vulnerability (PV-5).MethodsPatients with NMS were identified from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database. The 9442 patients identified were randomly divided into training and testing cohorts. Univariate and multivariable logistic regression were performed; variables significantly associated with complications were evaluated using the Akaike information criterion and area under the curve. Significant variables received weighted scores, and a patient-specific prediction model was generated and evaluated using the Brier score.ResultsPatients with central nervous system abnormality (OR 1.32 [95%CI 1.13-1.53]), hematologic disorder (OR 1.40 [1.06-1.85]), congenital malformation (OR 1.30 [1.1-1.54]), nutritional support (OR 2.21 [1.91-2.57]), and preoperative wound infection (OR 2.3 [1.4-3.76]) were more likely to develop complications after spinal fusion surgery. PV-5 scores were calculated from these risk factors to generate a prediction model. PV-5 scores of 1 (OR: 2.0 [1.27-3.43], P < 0.004), 2 (OR: 2.75 [1.63-4.64], P < 0.001), 3 (OR: 3.67 [2.18-6.19], P < 0.001), 4 (OR: 4.09 [2.39-6.99], P < 0.001), and 5+ (OR: 3.58 [1.35-9.47], P = 0.01) predicted greater complication risk than PV-5 of zero (accuracy = 89.65%, Brier score = 0.09).ConclusionsUsing factors associated with complications in children with NMS undergoing spinal fusion surgery, we created a prediction model to illustrate physiologic vulnerability and morbidity. Our model serves as a foundation for further body system-specific investigation.