Predictors of postoperative systemic inflammatory response syndrome after scoliosis surgery in adolescents with cerebral palsy: A retrospective analysis

Kesavan Sadacharam; Zhaoping He; Maureen F Edelson; Kimberly McMahon; Catherine Madurski; B Randall Brenn

doi:10.1016/j.xnsj.2022.100135

Predictors of postoperative systemic inflammatory response syndrome after scoliosis surgery in adolescents with cerebral palsy: A retrospective analysis

N Am Spine Soc J. 2022 Jun 11:11:100135. doi: 10.1016/j.xnsj.2022.100135. eCollection 2022 Sep.

Authors

Kesavan Sadacharam^{1

2}, Zhaoping He^{1

2}, Maureen F Edelson¹, Kimberly McMahon¹, Catherine Madurski¹, B Randall Brenn³

Affiliations

¹ Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
² Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
³ Shriner's Hospital for Children, Philadelphia, PA, USA.

Abstract

Background: Systemic inflammatory response syndrome (SIRS) is known to complicate postsurgical intensive care patients. We noticed that roughly half children with cerebral palsy who undergo posterior spinal fusion (PSF) for neuromuscular scoliosis developed SIRS in the intensive care unit. There is a paucity of literature detailing the impact of intraoperative causes of postoperative SIRS and downstream consequences in these patients. Study purpose was to understand the factors associated with SIRS in children who undergo PSF for neuromuscular scoliosis.

Methods: This retrospective, case control study included children who underwent PSF for neuromuscular scoliosis. Patients with idiopathic scoliosis, osteogenesis imperfecta, and tracheotomy were excluded. Subjects were divided into two study groups based on the diagnosis of SIRS in the intensive care unit. Descriptive statistical analysis was used to identify factors associated with SIRS; a regression analysis was used to further evaluate the independent and significant influence of these factors.

Results: There was no significant difference in the demographic and other preoperative variables. However, total blood products (ml/kg) administered was significantly higher among the SIRS group compared with the non-SIRS group (54.4±41.0 vs 34.1±21.5 P <0.034). Percent of patients remaining intubated was greater in the SIRS group compared with the non-SIRS group (44.1% vs 7.0%, P < 0.001). The regression model revealed that the odds to develop SIRS in patients who were not extubated were 7.467-fold higher (CI: 1.534-36.347) compared with those who were extubated (p=0.013).

Conclusions: The incidence of SIRS is significantly higher among the patients who were not extubated at the end of PSF surgery. Further prospective studies are needed to look at the factors that impede the ability to extubate these patients at the end of surgery.

Keywords: Children; Neuromuscular; Postoperative extubation; Scoliosis; Spinal fusion; Systemic inflammatory response syndrome.