Page 30 - WNS 2024 e-Program - Resized and Binded

Towards a Definition of Physiologic Vulnerability in Pediatric
Spine Surgery: Identification of Key Risk Factors in a Cohort
Study of Children with Neuromuscular Disease Undergoing
Spinal Fusion
Vijay M. Ravindra, MD, MSPH
Naval Medical Center San Diego, University of California San Diego
Muhammad S. Ghauri, MS 1 , Sujay Rajkumar, BS 2 , Lauren E. Stone, MD 3 ,
Michael P. Kelly, MD, MSCI 4 , Rajiv R. Iyer, MD 5,7 , Jennifer Bauer, MD 6 ,
Christopher Ames 7 , MD, Peter O. Newton, MD 4 , David D. Gonda, MD 8 ,
Michael L. Levy, MD, PhD 3 , Vijay M. Ravindra, MD, MSPH 3,4,5,9
1 School of Medicine, California University of Science and Medicine, Colton,
California, USA; 2 School of Medicine, Drexel University College of Medicine,
Philadelphia, Pennsylvania, USA 3 Department of Neurosurgery, University of
California San Diego, San Diego, California, USA 4 Division of Pediatric
Orthopedic Surgery, Rady Children’s Hospital, San Diego, California, USA
5 Division of Pediatric Neurosurgery, Primary Children’s Hospital, University
of Utah, Salt Lake City, Utah, USA; 6 Seattle Children's Hospital Department
of Orthopedic Surgery, University of Washington Department of
Orthopedics and Sports Medicine, Seattle, WA, USA; 7 Department of
Neurological Surgery, University of California, San Francisco, San Francisco,
CA.; 8 Division of Pediatric Neurosurgery, Rady Children’s Hospital, San
Diego, California, USA; 9 Department of Neurosurgery, Clinical
Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
Introduction: Preoperative risk stratification strategies using “frailty” are
commonplace for adults but are difficult to apply for children. We aim to
identify key risk factors that indicate physiologic vulnerability and predict
perioperative complications in a cohort of children with neuromuscular
scoliosis (NMS) and create a patient-specific prediction model for
physiological vulnerability (PV-5).

Methods: This is a retrospective cohort study of patients ≤18 years from the
National Surgical Quality Improvement Program-Pediatric database with
NMS who underwent spinal fusion surgery for correction. The primary
outcome was complication occurrence.
Patients were divided into training and testing cohorts. Univariate and
multivariate logistic regression were performed; variables significantly
associated with the primary outcome were evaluated using Akaike
information criterion and area under the curve (AUC). Significant variables
received weighted scores, and prediction scores were calculated to generate a
patient-specific prediction model. The final model’s performance was
evaluated using the Brier score.
Results: The study included 9442 patients with NMS. Patients with a
central nervous system abnormality (OR 1.32 [95%CI 1.13-1.53]),
hematologic disorder (OR 1.4 [1.06-1.85]), congenital malformation (OR 1.3
[1.1-1.54]), nutritional support (OR 2.21 [1.91-2.57]), and preoperative
wound infection (OR 2.3 [1.4-3.76]) were more likely to develop a
complication following spinal fusion surgery. PV-5 scores were calculated
from these risk factors to generate our final prediction model. Patients with
PV-5 scores of 1 (OR: 2.0 [1.27-3.43], p<0.004), 2 (OR: 2.75 [1.63-4.64],
p<0.001), 3 (OR: 3.67 [2.18-6.19], p<0.001), 4 (OR: 4.09 [2.39-6.99],
p<0.001), and 5+ (OR: 3.58 [1.35-9.47], p=0.01) were more likely to
experience complications than those with scores of 0 (accuracy=89.65%,
Brier score = 0.09).