Readmissions After Pediatric Spinal Fusion Surgery for Neuromuscular Scoliosis-are They Preventable?

Background: Children with neuromuscular disorders commonly develop scoliosis and undergo spinal fusion surgery. A previous single center study showed that unplanned readmission after pediatric spinal fusion surgery was 8%, with neuromuscular disorders were associated with a significant increased risk for readmission. Causes for readmission directly associated with the surgery were investigated, however indirect causes, such as post-operative pain and constipation were not assessed. Our objective was to evaluate the 90-day readmission rate for patients who underwent spinal fusion for neuromuscular scoliosis across multiple sites, and to determine the prevalence of preventable causes, such as pain and constipation.

Methods: Using data from Pediatric Health Information System (PHIS), we performed a retrospective cohort study of patients 18 years and younger, who underwent spinal fusion surgery for neuromuscular scoliosis and were readmitted within 90 days. For those readmitted, we assessed the frequency of pain and constipation as the principal readmitting diagnosis to tertiary care children’s’ hospitals in the USA between 2015 and 2018. The study was approved by the IRB.

Results: A total of 49 hospitals provided yearly data. A total of 8459 patients with neuromuscular disorders underwent spinal fusion surgery, of which 658 were readmitted within 90 days (7.8%). Readmissions due to pain and constipation constituted 18.8% and 4.3% of all readmissions, respectively. Rates of readmission for pain ranged from 1.3-1.7%, while rates of readmission for constipation ranged from 0.2-0.4% (Table 1).

Conclusion: The average 90-day readmission in pediatric populations following surgery for neuromuscular scoliosis is similar to patients without neuromuscular disorders(1). The number of patients readmitted for pain and constipation represent a significant portion of all patients readmitted. To address these potentially preventable causes of readmission, we propose that hospitals develop protocols and improve discharge planning that specifically addresses better pain control and effective bowel regimen for this medically complex population.

1) https://pubmed.ncbi.nlm.nih.gov/26091156/