Cardiac Risk Factors and Complications After Spinal Fusion for Idiopathic Scoliosis in Children

Background: Cardiac risk factors pose challenges in pediatric posterior spinal fusion (PSF). Differences in risk according to etiology of cardiac disease are unclear. We investigated outcomes of PSF according to presence of congenital heart defect compared to cardiomyopathy. Methods: Elective PSF for idiopathic scoliosis in patients aged 0-18 y was identified in the 2012-2015 National Surgical Quality Improvement Program-Pediatric. Cardiac risk factors were classified as: no cardiac risk factors or minor cardiac risk factors without congenital heart defect; minor cardiac risk factors because of congenital heart defect; major cardiac risk factors because of congenital heart defect; major cardiac risk factors because of cardiomyopathy. Multivariable logistic regression compared surgical site infection, wound dehiscence, hospital length of stay >= 30 d, and unplanned readmission across these categories. Results: The analysis included 5395 girls and 1691 boys, aged 14 +/- 2 y. Among these, 140 patients had minor cardiac risk factors because of congenital heart defect, 144 had major cardiac risk factors because of congenital heart defect, and 20 had major cardiac risk factors because of cardiomyopathy. Rates of any complication were significantly higher among patients with cardiomyopathy (40%) compared to patients with major cardiac risk factors because of congenital heart defect (10%), minor cardiac risk factors because of congenital heart defect, or other minor or no cardiac risk factors (5%; chi-square P < 0.001). In multivariable analysis of 6829 patients, cardiomyopathy predicted greater odds of unplanned readmission compared to no or minor cardiac risk factors (OR = 5.9; 95% CI: 1.8, 19.7; P = 0.004) and compared to major cardiac risk factors because of congenital heart defect (OR = 4.5; 95% CI: 1.1, 17.6; P = 0.032). Conclusions: Cardiomyopathy is a rare but significant risk factor for complications after pediatric PSF, whereas congenital heart defects did not independently contribute to risk of complications after this procedure. (C) 2018 Elsevier Inc. All rights reserved.