This multicenter retrospective cohort study of 7252 children with complex medical conditions looks at outcomes of children who undergo spinal fusion for scoliosis. Identified patients from a national US database of children’s hospitals by ICD codes. From these outcomes, the authors makes suggestions for pediatricians to help optimize their patients health prior to this procedure. As one might assume, increasing number of chronic medical conditions was associated with increased length of stay. More specifically, patients with bladder dysfunction, respiratory insufficiency, and epilepsy had most significant increased length of stay. One question that arose that could not be answered was if the above mentioned medical problems associated with longer LOS were directly related or if they were rather a marker for greater neurological impairment.

I find one of the hardest conversations to have with parents of children with medical complexity is about options for scoliosis. I find it easy to explain there are high rates of complications, long hospitalization, and long recovery periods with surgical options. The difficulty lies in determining which of my patients are at the most risk for poor outcomes. This is a study has helped these conversations with my families.

Kristie Malik, MD

Berry JG et al. Comorbidities and Complications of Spinal Fusion for Scoliosis. Pediatrics 2017 Mar; 139(3). PMID: 28153850