O1054: Preoperative Predictors for Postoperative Gastrointestinal Complications in Pediatric Neuromuscular Scoliosis Patients

Background: Neuromuscular scoliosis patients have a purportedly higher postoperative complication rate than those with adolescent idiopathic scoliosis. Of these, gastrointestinal (GI) issues are clinically well observed. However, there is limited data on the prevalence of postoperative GI complications, and the preoperative indicators that may predict them. The focus of this study is to determine the incidence and risk factors of gastrointestinal complications after neuromuscular scoliosis correction.

Methods: An IRB approved, retrospective case review of patient records from 2013 – 2019. Inclusion criteria focused on pediatric scoliosis patients ( < 18 years of age) with a neuromuscular diagnosis undergoing index procedures. Radiographic, clinical and hospital stay data was assessed. Patients were compared according to their postoperative gastrointestinal (GI) complication status. PO GI issues were described as either major or minor complications. Minor complications included continued nausea/vomiting, constipation, diarrhea and distention. Major complications included extended paralytic ileus, dysphagia, g-tube infections and gastroparesis based on literature and clinical experience. Data was presented as median and interquartile values in order to avoid the effects of outsider values. Statistically, Fisher’s Exact, Kruskal-Wallis and Chi-Squared tests were used.

Results: We included a total of 69 patients, of which, 36 developed PO GI issues. Age and BMI values were similar for both groups of patients (p = 0.367, p = 0.371). Of the patients that developed PO GI complications, the overwhelming majority exhibited minor complications only (94.3%). PO GI patients had a significantly longer length of stay (9 vs 6 days, p = 0.004). While preoperative major Cobb angles were similar, patients that developed PO GI issues had a significantly higher preoperative pelvic obliquity (15.80 cm vs. 7.55 cm, p = 0.040). Patients that developed PO GI issues were overwhelmingly classified with ASA scores of 3 or 4 (96.6%), were more likely to have a preoperative gastrostomy tube (p < 0.001), were significantly more likely to be fused to the pelvis (p = 0.009), had longer fusions (17 vs 15, p = 0.018) and had significantly more spastic presentations of their disease (p < 0.001). Both groups had similar preoperative albumin levels (p = 0.344), history of seizures (p = 0.132) and gastroesophageal reflux (p = 0.096). Patients with postoperative GI issues were significantly more likely to have a pre-existing GI such as aspiration, feeding issues and g-tube site complications (p = 0.023).

Conclusion: Spasticity, the presence of a pre-existing GI issue, presence of a g-tube, and notable pelvic tilt appear to be significant risk factors for postoperative gastrointestinal complications in neuromuscular scoliosis patient.