Prediction of delayed extubation and admission to intensive care units in children undergoing scoliosis posterior fusion surgery: a retrospective observational study
Authors: Wang Lai , Xia Qin , Ni Wenwen , Zhuang Di , Tong Xianya , Jiang Lai , Mao Yanfei 
Published: May 2023

Abstract
Background: Delayed postoperative extubation and admission to intensive care units (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay and increase medical costs. However, after scoliosis orthopaedic surgery, whether a child will require delayed extubation or ICU admission is not fully understood. This study reviewed the risk factors for delayed extubation and ICU admission after scoliosis orthopaedic surgery in children.Method: We reviewed and analysed the electronic medical records of paediatric patients (≤ 18 years) undergoing posterior spinal fusion surgery from January 2018 to November 2021. The patients’ characteristics (age, sex, body mass index, American Society of Anesthesiologists grade, preoperative lung function, combined heart disease), preoperative Cobb angle, scoliosis type, orthopaedic rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allotransfusion, intraoperative haemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg), surgical time, postoperative extubation and admission to the ICU were collected. The main outcomes were delayed postoperative extubation and postoperative admission to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and admission to the ICU.Results: We enrolled 246 children who met the inclusion criteria, of which 23 (9.3%) had delayed extubation and 81 (32.9%) were transferred to the ICU after surgery. High American Society of Anesthesiologists grade (odds ratio (OR) = 5.42; 95% confidence interval (CI): 1.49–19.78; P = 0.010), high Cobb angle (OR = 1.04; 95% CI: 1.02–1.07; P < 0.001), moderate to severe pulmonary dysfunction (OR = 10.9; 95% CI: 2.00–59.08; P = 0.006) and prolonged surgical time (OR = 1.01; 95% CI: 1.00–1.03; P = 0.040) were risk factors for delayed postoperative extubation. High Cobb angle (OR = 1.02; 95% CI: 1.01–1.04; P = 0.004), high intraoperative bleeding volume (OR = 1.06; 95% CI: 1.03–1.10; P = 0.001), allogeneic transfusion (OR = 3.30; 95% CI: 1.24–8.83; P = 0.017) and neuromuscular scoliosis (OR = 5.38; 95% CI: 1.59–18.25; P = 0.007) were risk factors for postoperative transfer to the ICU. High Cobb angle was a risk factor for both delayed postoperative extubation and admission to the ICU. Age, sex, body mass index, number of vertebral fusion segments, orthopaedic rate and intraoperative tidal volume were not associated with delayed postoperative extubation and admission to the ICU.Conclusions: The most common risk factor for delayed postoperative extubation and ICU admission in paediatric patients who underwent posterior spinal fusion was a high Cobb angle. Our results demonstrated that determining poor prognostic risk factors may help optimise perioperative management strategies for children undergoing complicated spinal surgery.