Respiratory Complications after Posterior Spinal Fusion for Neuromuscular Scoliosis: Children with Rett Syndrome at Greater Risk Than Those with Cerebral Palsy

Jacob L. Cohen, Walter Klyce, Sapna R Kudchadkar, Ronak N. Kotian, Paul David Sponseller

Research output: Contribution to journalArticle

Abstract

Study Design. Retrospective cohort. Objective. To determine how respiratory failure rates and duration of intensive care unit (ICU) stay after posterior spinal fusion (PSF) for neuromuscular scoliosis compare between children with Rett syndrome (RS) versus cerebral palsy (CP).Summary of Background Data. Rett syndrome and CP are associated with high incidence of neuromuscular scoliosis and respiratory dysfunction. Methods. We included 21 patients with RS (mean age, 13 ± 3.1 yrs) and 124 with CP (mean age, 14 ± 3.2 yrs) who underwent PSF by one surgeon from 2004 to 2017. Preoperative motor function was assessed using the Gross Motor Function Classification System (GMFCS). Primary outcomes were respiratory failure and duration of ICU stay. Secondary outcomes were pneumonia and prolonged use of positive pressure ventilation (PPV). Using multivariate regression, we identified associations of age, intraoperative vital signs, duration of hospital stay, number of vertebral levels fused, anesthesia and surgery durations, and estimated blood loss with longer ICU stay and respiratory failure. Results. A greater proportion of CP patients (96%) than RS patients (66%) were in GMFCS IV or V (P < 0.01). Respiratory failure was more common in RS patients (43% vs. 19%; P = 0.02), as was PPV (67% vs. 31%; P < 0.01). RS patients had shorter median durations of anesthesia and surgery (P < 0.01). RS patients had a longer median (interquartile range) ICU stay (4 days [1-5] vs. 2 days [2-19]; P = 0.01). Incidence of pneumonia did not differ between groups (P = 0.69). Only RS diagnosis (P = 0.02) and prolonged PPV (P < 0.01) were associated with longer ICU stay. Conclusion. Despite better preoperative motor function and shorter anesthesia and surgery durations, patients with RS experienced more respiratory failure, prolonged PPV use, and longer ICU stays after PSF than did children with CP.

Original languageEnglish (US)
Pages (from-to)1396-1402
Number of pages7
JournalSpine
Volume44
Issue number19
DOIs
StatePublished - Oct 1 2019

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Rett Syndrome
Spinal Fusion
Scoliosis
Cerebral Palsy
Intensive Care Units
Respiratory Insufficiency
Positive-Pressure Respiration
Anesthesia
Pneumonia
Vital Signs
Incidence
Respiratory Rate
Length of Stay

Keywords

  • cerebral palsy
  • intensive care unit
  • neuromuscular scoliosis
  • pediatrics
  • positive pressure ventilation
  • posterior spinal fusion
  • postoperative complications
  • reintubation
  • respiratory failure
  • Rett syndrome
  • spine

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Respiratory Complications after Posterior Spinal Fusion for Neuromuscular Scoliosis : Children with Rett Syndrome at Greater Risk Than Those with Cerebral Palsy. / Cohen, Jacob L.; Klyce, Walter; Kudchadkar, Sapna R; Kotian, Ronak N.; Sponseller, Paul David.

In: Spine, Vol. 44, No. 19, 01.10.2019, p. 1396-1402.

Research output: Contribution to journalArticle

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abstract = "Study Design. Retrospective cohort. Objective. To determine how respiratory failure rates and duration of intensive care unit (ICU) stay after posterior spinal fusion (PSF) for neuromuscular scoliosis compare between children with Rett syndrome (RS) versus cerebral palsy (CP).Summary of Background Data. Rett syndrome and CP are associated with high incidence of neuromuscular scoliosis and respiratory dysfunction. Methods. We included 21 patients with RS (mean age, 13 ± 3.1 yrs) and 124 with CP (mean age, 14 ± 3.2 yrs) who underwent PSF by one surgeon from 2004 to 2017. Preoperative motor function was assessed using the Gross Motor Function Classification System (GMFCS). Primary outcomes were respiratory failure and duration of ICU stay. Secondary outcomes were pneumonia and prolonged use of positive pressure ventilation (PPV). Using multivariate regression, we identified associations of age, intraoperative vital signs, duration of hospital stay, number of vertebral levels fused, anesthesia and surgery durations, and estimated blood loss with longer ICU stay and respiratory failure. Results. A greater proportion of CP patients (96{\%}) than RS patients (66{\%}) were in GMFCS IV or V (P < 0.01). Respiratory failure was more common in RS patients (43{\%} vs. 19{\%}; P = 0.02), as was PPV (67{\%} vs. 31{\%}; P < 0.01). RS patients had shorter median durations of anesthesia and surgery (P < 0.01). RS patients had a longer median (interquartile range) ICU stay (4 days [1-5] vs. 2 days [2-19]; P = 0.01). Incidence of pneumonia did not differ between groups (P = 0.69). Only RS diagnosis (P = 0.02) and prolonged PPV (P < 0.01) were associated with longer ICU stay. Conclusion. Despite better preoperative motor function and shorter anesthesia and surgery durations, patients with RS experienced more respiratory failure, prolonged PPV use, and longer ICU stays after PSF than did children with CP.",
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T2 - Children with Rett Syndrome at Greater Risk Than Those with Cerebral Palsy

AU - Cohen, Jacob L.

AU - Klyce, Walter

AU - Kudchadkar, Sapna R

AU - Kotian, Ronak N.

AU - Sponseller, Paul David

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N2 - Study Design. Retrospective cohort. Objective. To determine how respiratory failure rates and duration of intensive care unit (ICU) stay after posterior spinal fusion (PSF) for neuromuscular scoliosis compare between children with Rett syndrome (RS) versus cerebral palsy (CP).Summary of Background Data. Rett syndrome and CP are associated with high incidence of neuromuscular scoliosis and respiratory dysfunction. Methods. We included 21 patients with RS (mean age, 13 ± 3.1 yrs) and 124 with CP (mean age, 14 ± 3.2 yrs) who underwent PSF by one surgeon from 2004 to 2017. Preoperative motor function was assessed using the Gross Motor Function Classification System (GMFCS). Primary outcomes were respiratory failure and duration of ICU stay. Secondary outcomes were pneumonia and prolonged use of positive pressure ventilation (PPV). Using multivariate regression, we identified associations of age, intraoperative vital signs, duration of hospital stay, number of vertebral levels fused, anesthesia and surgery durations, and estimated blood loss with longer ICU stay and respiratory failure. Results. A greater proportion of CP patients (96%) than RS patients (66%) were in GMFCS IV or V (P < 0.01). Respiratory failure was more common in RS patients (43% vs. 19%; P = 0.02), as was PPV (67% vs. 31%; P < 0.01). RS patients had shorter median durations of anesthesia and surgery (P < 0.01). RS patients had a longer median (interquartile range) ICU stay (4 days [1-5] vs. 2 days [2-19]; P = 0.01). Incidence of pneumonia did not differ between groups (P = 0.69). Only RS diagnosis (P = 0.02) and prolonged PPV (P < 0.01) were associated with longer ICU stay. Conclusion. Despite better preoperative motor function and shorter anesthesia and surgery durations, patients with RS experienced more respiratory failure, prolonged PPV use, and longer ICU stays after PSF than did children with CP.

AB - Study Design. Retrospective cohort. Objective. To determine how respiratory failure rates and duration of intensive care unit (ICU) stay after posterior spinal fusion (PSF) for neuromuscular scoliosis compare between children with Rett syndrome (RS) versus cerebral palsy (CP).Summary of Background Data. Rett syndrome and CP are associated with high incidence of neuromuscular scoliosis and respiratory dysfunction. Methods. We included 21 patients with RS (mean age, 13 ± 3.1 yrs) and 124 with CP (mean age, 14 ± 3.2 yrs) who underwent PSF by one surgeon from 2004 to 2017. Preoperative motor function was assessed using the Gross Motor Function Classification System (GMFCS). Primary outcomes were respiratory failure and duration of ICU stay. Secondary outcomes were pneumonia and prolonged use of positive pressure ventilation (PPV). Using multivariate regression, we identified associations of age, intraoperative vital signs, duration of hospital stay, number of vertebral levels fused, anesthesia and surgery durations, and estimated blood loss with longer ICU stay and respiratory failure. Results. A greater proportion of CP patients (96%) than RS patients (66%) were in GMFCS IV or V (P < 0.01). Respiratory failure was more common in RS patients (43% vs. 19%; P = 0.02), as was PPV (67% vs. 31%; P < 0.01). RS patients had shorter median durations of anesthesia and surgery (P < 0.01). RS patients had a longer median (interquartile range) ICU stay (4 days [1-5] vs. 2 days [2-19]; P = 0.01). Incidence of pneumonia did not differ between groups (P = 0.69). Only RS diagnosis (P = 0.02) and prolonged PPV (P < 0.01) were associated with longer ICU stay. Conclusion. Despite better preoperative motor function and shorter anesthesia and surgery durations, patients with RS experienced more respiratory failure, prolonged PPV use, and longer ICU stays after PSF than did children with CP.

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KW - intensive care unit

KW - neuromuscular scoliosis

KW - pediatrics

KW - positive pressure ventilation

KW - posterior spinal fusion

KW - postoperative complications

KW - reintubation

KW - respiratory failure

KW - Rett syndrome

KW - spine

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