The Effect of Surgical Time on Perioperative Complications in Pediatric Neuromuscular Scoliosis: A Propensity-Matched Analysis

Abstract

Title: The Effect of Surgical Time on Perioperative Complications in Pediatric Neuromuscular Scoliosis: A Propensity-Matched AnalysisBackground: Neuromuscular scoliosis (NMS) is a spinal deformity that often does not respond well to conservative treatments. As such, surgery is usually required to prevent the progression of the scoliotic curvature. Though, this procedure can be associated with significant morbidity. The reported rates of perioperative complications for the pediatric NMS remains quite high, though quite varied. This study attempted to elucidate the correlation between surgical time and perioperative outcomes in pediatric NMS patients. Methods: Patients who underwent posterior spinal fusion surgery (PSF) for NMS between January 1, 2010, and December 31, 2019, at a single academic institution were identified using ICD coding and an operational REDCap database. Variables collected included: general demographics, major curve size, curve flexibility, total surgical time, number of segments fused, estimated blood loss, intraoperative and postoperative red blood cell transfusion, length of stay, surgical site infection, postoperative neurologic loss, and 90-day readmission. Standard descriptive statistics, including mean and standard deviation, were calculated. The patients meeting inclusion criteria were distributed into two groups: those with a surgical duration of less than 360 minutes and those with surgical duration greater than 360 minutes. This represented a treatment cohort and control cohort, respectively. These groups were then propensity score (PS) matched using nearest neighbor with a caliper of 0.5. The chi-square and Fisher exact tests were used to compare categorical variables between the groups when appropriate. The Wilcoxon Rank Sum and t-tests were used to compare continuous variables between groups. Results: A total of 126 patients met inclusion criteria and were identified for propensity score (PS) analysis. After matching, the impact of surgical duration on infection, 90-day readmission, estimated blood loss, and perioperative transfusion volume showed no statistically significant difference. Of the patients meeting inclusion criteria, there were only 13 infections over the ten years, resulting in a rate of approximately 10.3%. When observing the surgical time over the past ten years, there was a decrease in the duration of the procedure, from roughly 530 minutes in 2010 to 300 minutes in 2019. Conclusion: Our propensity-matched analysis of 126 patients undergoing primary PSFI demonstrated an inability to reject the null hypothesis in regard to the perioperative outcomes selected between shorter and longer surgery duration.