Abstract
Summary. 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. 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. 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. Rresults: 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<40% predicted, n=10) included
markers of sleep hypoventilation, including serum bicarbonate ≥29
mmol/L, morning pCO2 >50 mmHg (P=0.003), and overnight,
episodic CO2 retention of >7 mmHg, thus an additional 8
children with SCPF were identified. 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 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 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. Keywords:
Ventilation ; Pulmonary complications ; Scoliosis ; Polysomnography.