300 Section - Respiratory and Critical Care Complications After Pediatric Spinal Arthrodesis for Scoliosis in Patients with Cerebral Palsy

Children with cerebral palsy (CP) have reduced ventilatory reserve and increased aspiration risk, predisposing them to perioperative pulmonary complications. Spinal arthrodesis for scoliosis represents a major physiologic stressor, yet large electronic medical record (EMR)–based comparisons of postoperative respiratory and airway outcomes between children with CP and those with scoliosis alone remain limited. We compared 90-day postoperative respiratory and airway complications following pediatric scoliosis fusion in patients with CP versus those without CP.

Design:

We conducted a retrospective cohort study using TriNetX, a federated EMR database. Pediatric patients undergoing spinal arthrodesis for scoliosis were identified using diagnostic and procedural codes. Patients with both CP and scoliosis were compared with patients with scoliosis alone; spinal arthrodesis served as the index event. Outcomes within 90 days relevant to perioperative anesthetic and pain management included prolonged mechanical ventilation ( >96 hours), postoperative pneumonia, atelectasis, and tracheostomy placement. Results are reported using de-identified, aggregate data as event rates. 

Results:

In total, 5,801 pediatric patients undergoing spinal arthrodesis were identified, including 1,119 patients with CP and scoliosis and 4,682 with scoliosis alone. Within 90 days, CP patients experienced significantly higher rates of respiratory and airway complications. Prolonged mechanical ventilation occurred in 4.0% of CP patients versus 0.8% of non-CP patients (absolute risk difference [RD] 3.2%, p< 0.0001). Postoperative pneumonia occurred in 7.5% versus 1.4% (RD 6.1%, p< 0.0001), atelectasis in 8.3% versus 2.5% (RD 5.8%, p< 0.0001), and tracheostomy placement in 9.6% versus 2.3% (RD 7.3%, p< 0.0001).

Conclusion:

Cerebral palsy is associated with a 3–7% increase in postoperative respiratory and airway complications following pediatric scoliosis fusion. These findings support treating children with CP as a high-risk subgroup requiring early pulmonary optimization and opioid-sparing multimodal analgesia.