Highlights
- •EOS patients with musculoskeletal conditions more likely to have renal anomalies.
- •Epilepsy and pulmonary failure were risks for patients with pulmonary disease.
- •Clustered neurologic and pulmonary anomalies increased mortality risk.
- •Clustered musculoskeletal and cardiovascular anomalies increased length of stay.
Abstract
This study sought to assess comorbidity profiles unique to early-onset-scoliosis (EOS)
patients by employing cluster analytics and to determine the influence of isolated
comorbidity clusters on perioperative complications, morbidity and mortality using
a high powered administrative database. The KID database was queried for ICD-9 codes
pertaining to congenital and idiopathic scoliosis from 2003, 2006, 2009, 2012. Patients
<10 y/o (EOS group) were included. Demographics, incidence and comorbidity profiles
were assessed. Comorbidity profiles were stratified by body systems (neurological,
musculoskeletal, pulmonary, cardiovascular, renal). K-means cluster and descriptive
analyses elucidated incidence and comorbidity relationships between frequently co-occurring
comorbidities. Binary logistic regression models determined predictors of perioperative
complication development, mortality, and extended length-of-stay (≥75th percentile).
25,747 patients were included (Age: 4.34, Female: 52.1%, CCI: 0.64). Incidence was
8.9 per 100,000 annual discharges. 55.2% presented with pulmonary comorbidities, 48.7%
musculoskeletal, 43.8% neurological, 18.6% cardiovascular, and 11.9% renal; 38% had
concurrent neurological and pulmonary. Top inter-bodysystem clusters: Pulmonary disease
(17.2%) with epilepsy (17.8%), pulmonary failure (12.2%), restrictive lung disease
(10.5%), or microcephaly and quadriplegia (2.1%). Musculoskeletal comorbidities (48.7%)
with renal and cardiovascular comorbidities (8.2%, OR: 7.9 [6.6–9.4], p < 0.001).
Top intra-bodysystem clusters: Epilepsy (11.7%) with quadriplegia (25.8%) or microcephaly
(20.5%). Regression analysis determined neurological and pulmonary clusters to have
a higher odds of perioperative complication development (OR: 1.28 [1.19–1.37], p < 0.001)
and mortality (OR: 2.05 [1.65–2.54], p < 0.001). Musculoskeletal with cardiovascular
and renal anomalies had higher odds of mortality (OR: 1.72 [1.28–2.29], p < 0.001)
and extLOS (OR: 2.83 [2.48–3.22], p < 0.001). EOS patients with musculoskeletal conditions
were 7.9x more likely to have concurrent cardiovascular and renal anomalies. Clustered
neurologic and pulmonary anomalies increased mortality risk by as much as 105%. These
relationships may benefit pre-operative risk assessment for concurrent anomalies and
adverse outcomes.
Level of Evidence: III – Retrospective Prognostic Study.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Early-onset idiopathic scoliosis.in: Weinstein S. The Pediatric Spine: Practice and Principles. Raven Press, New York, NY1994: 421-430
- Infantile idiopathic scoliosis in the newborn.Int Orthop. 1998; 22: 82-86
- Prognosis in infantile idiopathic scoliosis.J Bone Joint Surg Br. 1980; 62-B: 151-154
- The natural history and prognosis of infantile idiopathic scoliosis.J Bone Joint Surg Br. 1955; 37-B: 400-413
- Growth as a corrective force in the early treatment of progressive infantile scoliosis.J Bone Joint Surg Br. 2005; 87: 1237-1247
- Scoliosis and the respiratory system.Paediatr Respir Rev. 2006; 7: 152-160
- The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.J Bone Joint Surg Am. 2003; 85-A: 399-408
- Medical and congenital comorbidities associated with spinal deformities in the immature spine.J Bone Joint Surg Am. 2007; 89: 34-41
- Mortality and morbidity in early-onset scoliosis surgery.Spine (Phila Pa 1976). 2013; 38: 324-327
- Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms.Spine (Phila Pa 1976). 1992; 17: 1091-1096
- Respiratory function and cosmesis at maturity in infantile-onset scoliosis.Spine (Phila Pa 1976). 2003; 28: 2397-2406
- Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis.J Bone Joint Surg Am. 2008; 90: 1272-1281
- Early-onset scoliosis: a review of history, current treatment, and future directions.Pediatrics. 2016; 137
- Early onset scoliosis: current concepts and controversies.Curr Rev Musculoskelet Med. 2012; 5: 102-110
- The role of serial casting in early-onset scoliosis (EOS).J Pediatr Orthop. 2012; 32: 658-663
- Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis.J Pediatr Orthop. 2012; 32: 664-671
- Complications of growth-sparing surgery in early onset scoliosis.Spine (Phila Pa 1976). 2010; 35: 2193-2204
- Subcutaneous rodding for progressive spinal curvatures: early results.J Pediatr Orthop. 2002; 22: 290-295
- Spinal instrumentation without fusion for progressive scoliosis in young children.J Pediatr Orthop. 1997; 17: 734-742
- Treatment of scoliosis. Correction and internal fixation by spine instrumentation.J Bone Joint Surg Am. 1962; 44-A: 591-610
- Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients.J Bone Joint Surg Am. 2010; 92: 2533-2543
- Complications incidence in the treatment of early onset scoliosis with growing spinal implants.Stud Health Technol Inform. 2012; 176: 334-337
- Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis.Clin Spine Surg. 2016; 29: E428-E433
- Risk factors for complications associated with growing-rod surgery for early-onset scoliosis.Spine (Phila Pa 1976). 2013; 38: E464-E468
- Risk factors for predicting complications associated with growing rod surgery for early-onset scoliosis.Clin Neurol Neurosurg. 2015; 136: 15-19
- Adapting a clinical comorbidity index for use with ICD-9 administrative databases.J Clin Epidemiol. 1992; 45: 613-619
- Predictors of hospital length of stay and 30-day readmission in cervical spondylotic myelopathy patients: an analysis of 3057 patients using the ACS-NSQIP database.World Neurosurg. 2018; 110: e450-e458
- Age at initiation and deformity magnitude influence complication rates of surgical treatment with traditional growing rods in early-onset scoliosis.Spine Deform. 2016; 4: 344-350
- Obstructive lung disease is common in children with syndromic and congenital scoliosis: a preliminary study.J Pediatr Orthop. 2013; 33: 781-785
- Infantile and juvenile scoliosis: the crooked path to diagnosis and treatment.AORN J. 2009; 90: 347-376
- Respiratory problems in the adolescent with developmental delay.Adolesc Med. 2000; 11: 617-631
- The prevalence of gastroesophageal reflux disease in institutionalized intellectually disabled individuals.Am J Gastroenterol. 1999; 94: 804-810
- The incidence and risk factors for short-term morbidity and mortality in pediatric deformity spinal surgery: an analysis of the NSQIP pediatric database.Spine (Phila Pa 1976). 2014; 39: 1225-1234
- In-hospital mortality and morbidity of pediatric scoliosis surgery in Japan.Medicine (Baltimore). 2018; 97e0277
- Incidence and risk factors for pneumonia after posterior lumbar fusion procedures: an ACS-NSQIP study.Spine (Phila Pa 1976). 2016; 41: 1058-1063
- Lung mechanics in individuals with spinal cord injury: effects of injury level and posture.J Appl Physiol. 2001; 90: 405-411
- Abnormalities associated with congenital scoliosis: a retrospective study of 226 Chinese surgical cases.Spine (Phila Pa 1976). 2013; 38: 814-818
- Congenital abnormalities of the urogenital tract in association with congenital vertebral malformations.J Bone Joint Surg Br. 2002; 84: 891-895
- A retrospective study of congenital cardiac abnormality associated with scoliosis.Asian Spine J. 2016; 10: 226-230
- Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the scoliosis research society morbidity and mortality database.Spine (Phila Pa 1976). 2012; 37: 1975-1982
- Defining rates and causes of mortality associated with spine surgery.Spine (Phila Pa 1976). 2014; 39: 579-586
- Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors.Eur Spine J. 2012; 21: 1633-1639
- Values and pitfalls of the use of administrative databases for outcomes assessment.J Urol. 2013; 190: 17-18
- Multicenter study on the value of ICD-9-CM codes for case identification of celiac disease.Ann Epidemiol. 2013; 23: 136-142
Article info
Publication history
Published online: January 09, 2019
Accepted:
December 10,
2018
Received:
August 5,
2018
Identification
Copyright
© 2018 Published by Elsevier Ltd.
