National trends in spinal fusion for pediatric patients with idiopathic scoliosis: demographics, blood transfusions, and in-hospital outcomes

Abstract

Study design: Analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample database.

Objective: To analyze trends in spinal fusion for pediatric patients with idiopathic scoliosis on a national level with regard to demographics, blood transfusions, and in-hospital outcomes.

Summary of background data: Spinal fusion for pediatric patients with idiopathic scoliosis is required for rapid curve progression. For such patients and their families, blood transfusions and complications are important aspects of the surgery.

Methods: The Nationwide Inpatient Sample database was used to identify pediatric patients with idiopathic scoliosis who underwent spinal fusion from 2000 to 2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Demographics of the patients were retrieved. Trends in demographics, blood transfusion methods, and in-hospital outcomes were analyzed.

Results: The total number of patients included in this study was 43,983. A total of 30.4% of patients received a blood transfusion. Predonated autologous blood transfusions decreased over time, whereas perioperative autologous blood transfusions increased over time (P < 0.05, respectively). The in-hospital overall complication rate was 14.4%. The respiratory complication rate was the highest among complications; however, the rate decreased over time (P = 0.003). In-hospital blood transfusion, complication, and mortality rates were high in certain subgroups of patients, such as those with increased Elixhauser Comorbidity Score and those who underwent anterior and posterior fusion. The mean length of hospital stay decreased over time (P = 0.043).

Conclusion: During the last decade, 30% of pediatric patients with idiopathic scoliosis who underwent spinal fusion received some type of blood transfusion; and strategies for blood transfusion methods have changed over the years. A decreasing trend in the respiratory complication rate and reduction in length of hospital stay may indicate better postoperative care.

Level of evidence: 3.