Primary versus Revision Spinal Fusion in Children: An Analysis of 74,525 Cases from The Nationwide Inpatient Sample

Rafael de la Garza Ramos, Rory R. Goodwin, Taylor Purvis, Isaac O. Karikari, Amer F. Samdani, Daniel Sciubba

Research output: Contribution to journalArticlepeer-review


STUDY DESIGN.: Retrospective cohort study of a nationwide database. OBJECTIVE.: To compare in-hospital outcomes for pediatric patients who underwent primary versus revision spinal fusion. SUMMARY OF BACKGROUND DATA.: There is limited data on outcomes after primary versus revision spinal fusion in children. METHODS.: Data from the Nationwide Inpatient Sample from 2002 to 2011 was analyzed. Pediatric patients (age <18) who underwent?≥?3 level spinal fusion were identified. Demographics, in-hospital complications, length of stay, and hospital charges were compared between primary and revision (re-fusion) procedures. All analyses were performed after application of discharge weights. RESULTS.: Data from 72,483 primary fusion and 2,042 revision fusion procedures (2.7%) were analyzed. Average length of stay was 7.9 days for the revision group and 6.6 for the primary group (p?=?0.022). Average total charges were $135,644 and $142,029 for the revision and primary fusion groups, respectively (p?=?0.252). The percentage of patients who developed at least one in-hospital complication was 16.7% in the revision group and 8.6% in the primary fusion group (p<0.001). Specific complications that were more common in the revision group were reintubation (4.3% vs. 2.3%, p?=?0.008), hemorrhage/hematoma (5.0% vs. 2.5%, p?=?0.001), wound complications (4.0% vs. 1.1%, p?<?0.001), accidental vessel/nerve puncture (2.6% vs. 0.8%), p?<?0.001), implant-related complications (5.3% vs. 0.4%, p?<?0.001), and incidental durotomy (2.1% vs. 0.3%, p?<?0.001). On multivariate analysis, revision procedures (OR 2.64; 95% CI, 1.93 – 3.59; p?<?0.001), male sex (OR 1.73; 95% CI, 1.52 – 1.98; p?<?0.001), and fusion of 8 or more spinal levels (OR 1.27; 95% CI, 1.09 – 1.47; p?=?0.001) were risk factors for complication development. CONCLUSION.: In this study, pediatric patients who underwent spinal re-fusion had significantly higher complication rates compared to patients who underwent primary fusion, consistent with previous investigations. Male patients and patients who underwent fusion of 8 or more spinal levels also had higher complication rates.Level of Evidence: 3

Original languageEnglish (US)
StateAccepted/In press - Oct 6 2016

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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