Revision risk after pediatric spinal deformity surgery: a nationwide study with 2-year follow-up |
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| Authors: | Sidsel Fruergaard Søren Ohrt-Nissen Frederik Taylor Pitter Kristian Høy Martin Lindberg-Larsen Søren Eiskjær Benny Dahl Martin Gehrchen |
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| Institution: | 1. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark;2. Spine Unit, Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark;3. Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B. Winsløvsvej 4, 5000, Odense C, Denmark;4. Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense C, Denmark;5. Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark;1. Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY, USA;2. Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, 535 East 70th St., New York, NY, USA;3. Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA;1. Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan;2. Department of Anatomy and Neuroscience, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan;1. Department of Orthopaedic Surgery, Stanford University, 430 Broadway Street, MC: 6342, Pavilion C, 4th Floor, Redwood City, CA 94063-6342;2. Department of Biomedical Data Science, Stanford University, 1265 Welch Road, Stanford, CA 94305;1. Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands;2. Division of Orthopaedic Surgery, The Children''s Hospital of Philadelphia (CHOP), Philadelphia, PA, USA;1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;2. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;3. Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA 02462, USA;4. Department of Neurosurgery, North Shore Medical Center, Boston, MA 01923, USA;5. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA 02114, USA;6. Department of Orthopaedic Surgery, Brigham and Women''s Faulkner Hospital, Boston, MA 02130, USA;1. Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women''s Hospital, 60 Fenwood Rd, Boston, MA 02115 USA;2. Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA;3. Division of Rheumatology, Section of Clinical Sciences, Immunology and Allergy, Brigham and Women''s Hospital, 60 Fenwood Rd, Boston, MA 02115 USA;4. Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntingon Ave, Boston, MA 02115 USA;5. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, 75 Francis St, Boston, MA 02115 USA;6. Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave 3rd floor, Boston, MA 02118 USA;7. Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, 9th floor, Boston, MA 02114 USA |
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| Abstract: | BACKGROUND CONTEXTRevision risk after pediatric spine surgery is not well established and varies between deformity etiologies.PURPOSETo report the 2-year revision risk following surgery for primary pediatric spinal deformity in a nationwide cohort and to evaluate potential risk factors and reasons for revision surgery.DESIGNRetrospective nationwide cohort study.PATIENT SAMPLEA national registry study of all pediatric spinal deformity patients undergoing surgery during 2006–2015 (n=1310).OUTCOME MEASURESTwo-year revision risk.METHODSAll patients ≤21 years of age undergoing spinal deformity surgery in Denmark during 2006–2015 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on revision surgery were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for revision in all patients. Potential risk factors for revision were assessed with multiple logistic regression analyses and included age, etiology, sex, Charlson comorbidity index (CCI), and growth-preserving treatment.RESULTSPatients were categorized according to etiology: idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann's kyphosis (5%), and syndromic deformity (3%). Of 1,310 included patients, 9.2% underwent revision surgery within 2 years and 1.5% was revised more than once. Median time to revision was 203 (interquartile range 35–485) days. The multivariable logistic regression found significantly higher odds ratio (OR) for revision in patients with growth-preserving treatment (OR=5.1, 95% confidence interval CI] 2.6–10.1), congenital deformity (OR=2.7, 95% CI 1.3–5.3), spondylolisthesis (OR=3.5, 95% CI 1.9–6.7), Scheuermann kyphosis (OR=3.9, 95% CI 1.9–8.3), and CCI score ≥3 (OR=2.5 95% CI 1.1–5.6). The most common reason for revision was implant failure (32.5%) followed by residual deformity and/or curve progression (15.8%).CONCLUSIONSIn this nationwide study, the 2-year revision risk after primary pediatric spinal deformity surgery is 9.2%. Risk factors for revision are etiology of congenital deformity, spondylolisthesis, Scheuermann kyphosis as well as patients with growth-preserving treatment and higher CCI. The most common reason for revision is implant failure. |
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