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Patient Demographics and In-Hospital Complications Associated with Operative Scheuermann Kyphosis in Pediatric Patients

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BACKGROUND: Scheuermann kyphosis (SK) is a structural kyphotic deformity of the spine. Although typically managed conservatively, spinal fusion can be performed for refractory symptoms. Complications associated with spinal fusion for SK have been studied in the literature, although the in-hospital complication rate has not been described. Our study attempts to describe the patient demographics and in-hospital complication rate in pediatric patients undergoing spinal fusion for SK and compare this to pediatric patients undergoing spinal fusions for other diagnoses. MATERIALS AND METHODS: Pediatric discharges (age<18) from 2002 to 2013 were selected from the HCUP National Inpatient Sample. For each discharge, demographics data were collected in addition to information on comorbidities and post-operative complications. Comparisons between patients with SK who underwent spinal fusion (fusion+SK) and those who did not have SK but underwent spinal fusion (fusion without SK) were performed using the Chi-square test of independence with significance set at alpha<0.05. Simple logistic regression models were performed predicting complication (yes/no) with gender, comorbidity, primary payer, age group, and hospital bed size. RESULTS: From 2002 to 2013, a total weighted sample size of 115,002 patients had a spinal fusion. Of those patients, 1,839 had SK. Of the discharges with fusion+SK, 7.96% had at least one complication. Of the discharges with fusion without SK, 11.63% had at least one complication(P=0.0205). Of the discharges with fusion+SK, 34% were female, while 64% of those with fusion without SK were female(P<0.0001). There is statistically significant evidence that the proportions of discharges for the three primary payers differs for those with fusion+SK and those with fusion without SK(P=0.0044). Of the discharges with fusion+SK, the primary payer was Medicare/Medicaid in 19%, private/HMO in 73%, and other in 7%, compared 27% Medicare/Medicaid, 66% private/HMO, and 7% other for fusion without SK. The proportion of discharges with fusion+SK and for fusion without SK that were of white race was 85% and 65% respectively(P<0.0001). The simple logistic regression model with comorbidity, primary payer, age, gender, or hospital bed size predicting complication was not statistically significant. CONCLUSIONS: The in-hospital complication rate for pediatric patients undergoing spinal fusion for SK was 7.96%. Compared to all pediatric patients undergoing spinal fusion, patients undergoing spinal fusion for SK were more likely to be white, male, and have private insurance as their primary payer. Overall, the in-hospital complication rate in patients undergoing operative correction of SK is comparable to pediatric patients undergoing spinal fusion for other diagnoses.

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