Risk factors for pulmonary complications after posterior spinal instrumentation and fusion in the treatment of congenital scoliosis: a case-control study.
BACKGROUND
Although surgery prevents the progression of deformity and maintains the overall balance of the spine in congenital scoliosis (CS) patients, it is associated with a high risk of perioperative complications. Pulmonary complication is one of the most common complications. This retrospective study aimed to investigate the risk factors for pulmonary complications in CS patients after posterior spinal instrumentation and fusion.


METHODS
Analysis of consecutive patients who underwent posterior spinal instrumentation and fusion for congenital scoliosis was performed. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for pulmonary complications. Patients were separated into groups with and without postoperative pulmonary complications. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of pulmonary complications.


RESULTS
Three hundred and twenty-three CS patients were included. Forty-five (13.9%) patients developed postoperative pulmonary complications, which included pleural effusion in 34 (75.6%) cases, pneumonia in 24 (53.3%) cases, pneumothorax in 3 (6.7%) cases, atelectasis in 4 (8.9%) cases, pulmonary edema in 2 (4.4%) cases, respiratory failure in 2 (4.4%) cases, and prolonged mechanical ventilation in 4 (8.9%) cases. The independent risk factors for development of pulmonary complications included age (Odds ratio (OR) = 1.088, P = 0.038), reoperation (OR = 5.150, P = 0.012), preoperative pulmonary disease (OR = 10.504, P = 0.004), correction rate (OR = 1.088, P = 0.001), middle thoracic screw-setting (OR = 12.690, P = 0.043), and thoracoplasty (OR = 5.802, P = 0.001). The area under the receiver operating characteristic (ROC) curve based on predicted probability of the logistic regression was 0.903.


CONCLUSIONS
Age, reoperation, preoperative pulmonary disease, correction rate, middle thoracic screw-setting, and thoracoplasty were independent risk factors for pulmonary complications after posterior spinal instrumentation and fusion in CS patients.
['Wu|Lei|L|', 'Zhang|Xi-Nuo|XN|', 'Wang|Yun-Sheng|YS|', 'Liu|Yu-Zeng|YZ|', 'Hai|Yong|Y|']
D000293:Adolescent D000328:Adult D000367:Age Factors D001863:Bone Screws D016022:Case-Control Studies D002648:Child D005260:Female D006801:Humans D008171:Lung Diseases D008297:Male D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors D012600:Scoliosis D013123:Spinal Fusion D013904:Thoracic Vertebrae D013905:Thoracoplasty D016896:Treatment Outcome D055815:Young Adult
Risk factors Pulmonary complications Posterior spinal instrumentation and fusion Congenital scoliosis