IFPOS 34th Annual Meeting

IFPOS 34th Annual Meeting The Author(s) 2015. This article is published with open access at Springerlink.com April 16 IFPOS session 14:20–18:30 VIEUX PORT 300 IOP1/14:20–14:25 Postoperative complications following spinal fusions in children with neuromuscular scoliosis Tristan Nishnianidze, Ilhan A Bayhan, Oussama Abousamra, Kenneth J Rogers, Kirk W Dabney, Freeman Miller NAIDHC, Wilmington DE, United States NAIDHC, Wilmington, United States Purpose: Cerebral Palsy (CP) patientscommonly have progressive scoliosis that may require posterior spinal fusion (PSF) surgery. The purpose of this study was to define the relationship between preoperative and post-operative clinical factors with postoperative complications and outcomes. Methods: A retrospective review was completed on patients who had PSF for neuromuscular scoliosis between 2004 and 2013 at one institution. Three different instrumentation types were used: unit rod, pedicle screws or hybrid construct implant. Preoperative risk factors included GMFCS, CP diagnosis, nutritional status, mental retardation, severity of spinal deformity, ambulatory status, seizure, physical functional level, speech capacity, feeding ability, cognitive ability and laboratory values. Post-operative clinical course data was collected and included: events in the hospital; complications; and infection types. Results: Three hundred and two children with neuromuscular scoliosis were included with a mean age of 14.6 ± 3.0 years. Mean weight and height were 35.6 kg (+12.7; Z = -2.8 + 4.8) and 138.7 cm (+23.44; Z = -2.8 + (3.3), respectively. GMFCS 5 (205, 67.9 %) was highest in frequency. G-tube and seizure were present in 55 and 58 % of patients. Mean length of days for ICU and total hospitalization were 6 and 16, respectively. Highest frequency instrumentation was Unit rod (205, 66 %). Post-op superficial and deep wound infection rates were 0.027 %, respectively with an average discharge of 28.33 + 21 days. Post-operative complication rates were the following: pneumothorax (16, 5.1 %), post-op reintubation (7, 2.3 %), hyperalimentation (128, 41.2 %), atelectasis (15, 4.8 %), pleural effusion (129, 41.5 %), pneumonia (1, 0.3 %), transfusion reaction (1, 0.3 %), constipation (25, 8.0 %), and pancreatitis (193, 62.1 %). Infection rates post-op were the following: pulmonary (7, 2.3 %), urinary (2, 0.6 %), and septicemia (9, 2.9 %). Average first feed day was 6 + 2. Highest relative risk (rr) factors were calculated for pancreatitis, septicemia, hyperalimentation, deep wound infection, and atelectasis: Pre-op positive weight Z-score [ rick constipation (r/r1.559); pre-op seizure[ risk infection (rr = 1.224); pre-op seizure [ risk pneumothorax (1.417); pre-op seizure [ risk atelectasis (rr = 1.39); pre-op seizure [ risk hyperalimentation (rr = 2.039); preop G-tube [ risk pancreatitis (rr = 1.388); pre-op G-tube[ risk deep wound infection (rr = 1.715); Conclusion: G-tube and seizure activity (pre-op or post-op) had the highest relative risk value for the primary complications that occurred post-operatively. Significance: Complications after posterior spinal fusion in CP are strongly associated with preoperative positive seizure activity, G-tube feeding and positive weight z-score. April 16 IFPOS session 14:20–18:30 VIEUX PORT 300 IOP2/14:25–14:30 Guided growth of the proximal femur for spastic hip displacement in children with cerebral palsy