1
|
Demura S, Ohara T, Tauchi R, Takimura K, Watanabe K, Suzuki S, Uno K, Suzuki T, Yanagida H, Yamaguchi T, Kotani T, Nakayama K, Watanabe K, Yokogawa N, Oku N, Tsuchiya H, Yamamoto T, Kawamura I, Taniguchi Y, Takeshita K, Sugawara R, Kikkawa I, Sato T, Fujiwara K, Akazawa T, Murakami H, Kawakami N. Incidence and causes of instrument-related complications after primary definitive fusion for pediatric spine deformity. J Neurosurg Spine 2023; 38:192-198. [PMID: 36461844 DOI: 10.3171/2022.8.spine22729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Various complications have been reported in the treatment of pediatric spinal deformities. Among these, instrument-related complications could be critical concerns and risks of reoperation. This study aimed to identify the incidence and causes of complications after primary definitive fusion for pediatric spine deformities. METHODS The authors retrospectively collected data from 14 institutions about patients who underwent primary definitive fusion between 2015 and 2017. There were 1490 eligible patients (1184 female and 306 male), with a mean age of 13.9 years. The incidence, causes, and reoperation rates were analyzed according to 4 etiologies of pediatric spine deformity (congenital, neuromuscular, syndromic, idiopathic). The complications were also categorized as screw-, hook-, or rod-related complications, implant loosening or backout, and junctional problems. RESULTS The incidence of overall instrument-related complications was 5.6% (84 cases). Regarding etiology, the incidence rates were 4.3% (idiopathic), 6.8% (syndromic), 7.9% (congenital), and 10.4% (neuromuscular) (p < 0.05). The most common causes were pedicle screw malposition (60.7%), followed by implant backout or loosening (15.4%), junctional problems (13.1%), rod breakage (4.8%), and other complications (6.0%). Univariate analysis showed that etiology, type of deformity (kyphosis), surgical procedure, operation time, and estimated blood loss were significant factors. Multivariate analysis revealed that etiology (neuromuscular), surgical procedure (combined approach), and operation time (> 5 hours) remained as significant risk factors. Among all patients with instrument-related complications, 45% (38/84) required revision surgery. Of these cases, > 50% were related to pedicle screw malposition. Medial breach was the most common complication regardless of location, from upper thoracic to lumbar spine. CONCLUSIONS Pedicle screw malposition was the primary cause of overall complications and subsequent reoperation. In addition to more precise screw insertion techniques, meticulous confirmation of pedicle screw placement, especially of medial breach, may reduce the overall instrument-related complications and revision rates.
Collapse
Affiliation(s)
- Satoru Demura
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Tetsuya Ohara
- 2Department of Orthopaedic Surgery, Meijo Hospital, Nagoya
| | - Ryoji Tauchi
- 2Department of Orthopaedic Surgery, Meijo Hospital, Nagoya
| | | | - Kota Watanabe
- 3Department of Orthopaedic Surgery, Keio University, Tokyo
| | - Satoshi Suzuki
- 3Department of Orthopaedic Surgery, Keio University, Tokyo
| | - Koki Uno
- 4Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe
| | - Teppei Suzuki
- 4Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe
| | - Haruhisa Yanagida
- 5Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Toru Yamaguchi
- 5Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Toshiaki Kotani
- 6Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba
| | - Keita Nakayama
- 6Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba
| | - Kei Watanabe
- 7Department of Orthopedic Surgery, Niigata University, Niigata
| | - Noriaki Yokogawa
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Norihiro Oku
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Hiroyuki Tsuchiya
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Takuya Yamamoto
- 8Department of Orthopaedic Surgery, Kagoshima Red Cross Hospital, Kagoshima
| | - Ichiro Kawamura
- 9Department of Orthopaedic Surgery, Kagoshima University, Kagoshima
| | - Yuki Taniguchi
- 10Department of Orthopaedic Surgery, The University of Tokyo, Tokyo
| | | | - Ryo Sugawara
- 11Department of Orthopedic Surgery, Jichi Medical University, Tochigi
| | - Ichiro Kikkawa
- 12Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi
| | - Tatsuya Sato
- 13Department of Orthopaedics, Juntendo University School of Medicine, Tokyo
| | - Kenta Fujiwara
- 14Department of Orthopaedics, Osaka Medical and Pharmaceutical University, Osaka
| | - Tsutomu Akazawa
- 15Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa
| | - Hideki Murakami
- 16Department of Orthopaedic Surgery, Iwate Medical University, Iwate; and
| | - Noriaki Kawakami
- 17Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | | |
Collapse
|
2
|
Brungardt JG, Liebscher SC, Schropp KP. Malrotation Correction in the Adult Population. World J Surg 2020; 45:141-147. [PMID: 32975648 DOI: 10.1007/s00268-020-05790-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Malrotation is a congenital anomaly most often affecting the pediatric population. The Ladd procedure is the standard treatment for this pathology. Well-studied in the pediatric population, large studies of the demographics and outcomes of patients who reach adulthood are lacking. METHODS An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with a post-operative diagnosis of malrotation and who underwent surgical correction with or without appendectomy, excluding those who underwent other major procedures such as colectomy. Baseline demographics and outcomes were compared. The primary outcome was mortality. Secondary outcomes such as length of stay and discharge destination were included. RESULTS Two hundred twenty patients undergoing surgical correction of malrotation were captured, all of which were performed by a general surgeon under general anesthesia. One hundered and nine (49.55%) of these patients also underwent an appendectomy. Most of these patients were female (68.18%). Comorbidities and perioperative variables were clinically similar. Operative time was similar between the two groups (112 ± 86 vs. 98 ± 49 min, p = 0.1385). Thirty-day mortality (1.36%), length of stay (4.79 ± 6.21 days), readmission rate (13.64%), wound infection (2.27%) and discharge destination (95.00% to home) were statistically similar between groups. CONCLUSIONS The data describes demographics and outcomes in adults undergoing Ladd procedures with and without appendectomy. Immediate outcomes may be equivalent regardless of incidental appendectomy. Further work is necessary to describe the population of adults with malrotation reaching adulthood.
Collapse
Affiliation(s)
- Joseph G Brungardt
- Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA.
| | - Sean C Liebscher
- Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA
| | - Kurt P Schropp
- Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA
| |
Collapse
|
3
|
Taylor D, Habre W. Risk associated with anesthesia for noncardiac surgery in children with congenital heart disease. Paediatr Anaesth 2019; 29:426-434. [PMID: 30710405 DOI: 10.1111/pan.13595] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/09/2019] [Accepted: 01/22/2019] [Indexed: 12/31/2022]
Abstract
Database analysis has indicated that perioperative cardiac arrest occurs with increased frequency in children with congenital heart disease. Several case series and large datasets from ACS NSQIP have identified subgroups at the highest risk. Consistently, patients with single ventricle physiology (especially prior to cavopulmonary anastomosis), severe/supra-systemic pulmonary hypertension, complex lesions, and cardiomyopathy with significantly reduced ventricular function have been shown to be at increased risk for adverse events. Based on these results, algorithms for assessing risk have been proposed. How hospitals and health care systems apply these guidelines to provide safe care for these challenging patient groups requires the application of modern quality improvement techniques. Each institution should develop a system which reflects local expertise and resources.
Collapse
Affiliation(s)
- Dan Taylor
- Department of Paediatric Anaesthesia, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trusts, London, UK
| | - Walid Habre
- Paediatric Anaesthesia Unit, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Miller R, Tumin D, McKee C, Raman VT, Tobias JD, Cooper JN. Population-based study of congenital heart disease and revisits after pediatric tonsillectomy. Laryngoscope Investig Otolaryngol 2019; 4:30-38. [PMID: 30828616 PMCID: PMC6383313 DOI: 10.1002/lio2.243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/20/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Accurate assessment of risk factors such as congenital heart disease (CHD) can aid in risk stratification of children presenting for surgery. Risk stratification is especially important in tonsillectomy ± adenoidectomy (T/A), a common pediatric procedure that is usually performed electively, but that has a high rate of adverse events. In this study, we examined the association of CHD with revisits after T/A. Methods We identified children who underwent T/A at hospitals and hospital‐owned facilities during 2010 to 2014 using the State Inpatient Databases and State Ambulatory Surgery and Services Databases of Florida, Georgia, Iowa, New York, and Utah. We evaluated the association between CHD severity and the occurrence of an unplanned hospital readmission or ED visit within 30 days following discharge using multivariable logistic regression. Results The analysis included 244,598 patients, of whom 858 had minor or major CHD. In multivariable analysis, CHD was not associated with an increased risk of 30‐day revisits (minor OR = 1.1; 95% CI: 0.8, 1.5; P = .65; major OR = 1.2; 95% CI: 0.9, 1.6; P = .34). Other comorbidities, including chromosomal anomalies (OR = 1.4; 95% CI: 1.2, 1.6; P < .001), congenital airway anomalies (OR = 1.3; 95% CI: 1.03, 1.7; P = .03), and neuromuscular impairment (OR = 1.4; 95% CI: 1.2, 1.7; P < .001) predicted an increased likelihood of revisits. Conclusion Neither minor nor major CHD was independently associated with an increased risk of 30‐day revisits among children undergoing T/A. Other characteristics, particularly non‐cardiac comorbidities, socioeconomic status, and geographic region may be of greater utility for predicting revisit risk following pediatric T/A. Level of Evidence 2b
Collapse
Affiliation(s)
- Rebecca Miller
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.,Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
| | - Christopher McKee
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.,Department of Anesthesiology and Pain Medicine The Ohio State University College of Medicine Columbus Ohio
| | - Vidya T Raman
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.,Department of Anesthesiology and Pain Medicine The Ohio State University College of Medicine Columbus Ohio
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.,Department of Anesthesiology and Pain Medicine The Ohio State University College of Medicine Columbus Ohio
| | - Jennifer N Cooper
- The Research Institute Nationwide Children's Hospital Columbus Ohio.,Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
| |
Collapse
|
5
|
Impact of Cardiac Risk Factors on Complications Following Cranial Vault Remodeling: Analysis of the 2012 to 2016 National Safety Quality Improvement Program-Pediatric Database. J Craniofac Surg 2019; 30:442-447. [PMID: 30615003 DOI: 10.1097/scs.0000000000005114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Congenital cardiac malformations have been reported in 8% of patients with craniosynostosis undergoing cranial vault remodeling (CVR), but associations with surgical outcomes are unknown. This study evaluated postoperative complications in patients who underwent CVR for craniosynostosis with or without cardiac risk factors (CRF) using the National Safety Quality Improvement Program-Pediatric (NSQIP-P) database. NSQIP-P database was queried for patients <2 years with craniosynostosis who underwent CVR from 2012 to 2016 based on diagnosis and procedure codes. The primary outcome was a composite of available NSQIP-P complications. Analysis compared patients with craniosynostosis based on the presence or absence of CRF. Univariate and multiple logistic regression identified risk factors associated with postoperative complications. A total of 3293 patients met inclusion criteria (8% with CRF). Two-thirds of patients experienced at least 1 complication, though patients with CRF experienced a greater proportion (74% vs 66%, P = 0.001). Univariate analysis identified associations between post-operative complications and age, ASA class, supplemental oxygen, neuromuscular disorders, preoperative nutritional supplementation, interventricular hemorrhage, and CRF. On multivariate regression, only older age (OR 1.17, 95% CI 1.01-1.36) and longer operative duration (OR 1.01, 95% CI 1.01-1.01) were associated with greater odds of postoperative complications. The most common complication in patients with craniosynostosis who undergo CVR is bleeding requiring transfusion. Older age and longer operative duration were associated with postoperative complications. Although patients with CRF have more postoperative complications, CRF was not a risk factor on adjusted analysis.
Collapse
|
6
|
Estimating Surgical Risk in Younger and Older Children With Congenital Heart Disease. J Surg Res 2018; 232:298-307. [DOI: 10.1016/j.jss.2018.06.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022]
|
7
|
Goodenough CJ, Anderson KT, Smith KE, Hanfland RA, Wadhwa N, Teichgraeber JF, Greives MR. Impact of Cardiac Risk Factors in the Postsurgical Outcomes of Patients With Cleft Palate: Analysis of the 2012-2014 NSQIP Database. Cleft Palate Craniofac J 2018; 56:595-600. [DOI: 10.1177/1055665618799224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To assess the risk of complication in patients undergoing cleft palate repair with congenital cardiac comorbidities in a large, national cohort. Design: Retrospective review. Patients/Setting: Using the 2012-2014 National Surgical Quality Improvement Program (NSQIP) Pediatric database, patients undergoing cleft palate repair were selected for analysis. Patients with cleft palate repairs were stratified based on the presence or absence congenital cardiac comorbidities. Univariate and stepwise forward logistic regression were conducted. Main Outcome Measures: It is hypothesized that risk of postoperative adverse events in patients with congenital cardiac comorbidities is higher than in patients without cardiac disease. Results: Nationally, between 2012 and 2014, 3240 patients underwent cleft palate repair, 422 (13.0%) with cardiac disease, and 2818 (87.0%) without cardiac disease. Patients with cardiac disease were smaller (10.5 [6.6] kg vs 11.6 [8.6] kg, P < .01) and more likely to be premature (4.6% vs 13.0%, P < .01) compared to those without cardiac disease. Postoperatively, patients with cardiac conditions were more likely to experience an adverse event (8.8% vs 4.2%, P < .01). Specifically, they were more likely to experience reintubation (1.7% vs 0.4%, P < .01), reoperation (2.1% vs 0.6%, P < .01), and longer length of stay (2.7 [7.0] vs 1.6 [2.8] days, P < .01). Rates of surgical site infection and dehiscence were not different. Conclusions: Cleft palate repair in patients with concurrent congenital cardiac defects is a safe procedure but carries elevated risk in the postoperative period as demonstrated in this analysis of the NSQIP-Pediatric database. Technical risks are equivalent. Additional anesthesia and surgical awareness of these potential complications is essential to minimize perianesthesia risks.
Collapse
Affiliation(s)
- Christopher J. Goodenough
- Department of General Surgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Kathryn T. Anderson
- Department of Pediatric Surgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Kari E. Smith
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Robert A. Hanfland
- Division of Pediatric Cardiac Surgery, Department of Pediatric Surgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Nitin Wadhwa
- Division of Pediatric Anesthesia, Department of Anesthesia, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - John F. Teichgraeber
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Matthew R. Greives
- Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston and Children’s Memorial Hermann Hospital, Houston, TX, USA
| |
Collapse
|