Risk Factors for Postoperative Pulmonary Complications in Children with Severely Compromised Pulmonary Function secondary to severe scoliosis.

OBJECTIVES: After corrective for scoliosis, postoperative pulmonary complications lead to increases in morbidity, length of hospital stay and mortality. This study aimed to identify associations with such respiratory complications, and to assess the utility of non-invasive ventilation in children with severe scoliosis METHODS: This retrospective cohort study included all children aged ≤17 years who underwent spinal surgery for scoliosis between January 2009 and January 2012 at a quaternary paediatric hospital. Data were collated regarding polysomnography (PSG) and NIV use, before and after corrective surgery. Factors associated with severely compromised pulmonary function (SCPF) were established and correlations with the occurrence of postoperative pulmonary complications and length of hospital stay (LOS) were identified. RESULTS: Altogether, 133 children had corrective surgery for scoliosis, aged 12.7 (range 2-17) years at operation. Scoliosis causes were identified as: idiopathic (39.8%), neuromuscular disease (32.2%), syndrome (15.7%) and congenital (12%). Correlates with SCPF (FVC 50 mmHg (P=0.003), and overnight, episodic CO2 retention of >7 mmHg. Using these parameters an additional 8 children with SCPF were identified making a total of 18/133 (13.5%) of the patients. Post-operative pulmonary complications were seen in 24 children (18%) and their occurrence correlated with higher Cobb angle (>90°), lower pulmonary function (FVC), higher serum bicarbonate and underlying neuromuscular disease. Amongst the 18 children with SCPF, regular use of NIV pre-operatively was associated with reduced rate of post-operative pulmonary complications (P =0.02) and reduced LOS by 6.4 days (P =0.01). CONCLUSION: Nocturnal hypoventilation on PSG identifies children with SCPF. Use of NIV in children with SCPF was linked to fewer post-operative pulmonary complications and reduced duration of hospital stay. This article is protected by copyright. All rights reserved.