Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 32772734.
- Also identified by DOI 10.1177/2192568220942482 and PMC identifier 8453676.
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Abstract
Retrospective review of consecutive series. This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m<sup>2</sup>, <i>P</i> = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, <i>P</i> = .87.), coronal Cobb angle (95° vs 88.5°, <i>P</i> = .43), preoperative forced vital capacity (45.3% vs 62.0%, <i>P</i> = .02), preoperative FEV<sub>1</sub> (forced expiratory volume in 1 second) (41.9% vs 63.1%, <i>P</i> < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV<sub>1</sub> (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, <i>P</i> = .013). The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV<sub>1</sub> was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.