Postoperative Mechanical Ventilation for Children With Medical Complexity Undergoing Spinal Fusion: A Pediatric Health Information System Database, 2016–2021 Cohort

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Abstract
OBJECTIVES: To assess the prevalence and factors associated with duration of postoperative invasive mechanical ventilation (IMV) in children with medical complexity undergoing spinal fusion. DESIGN: Retrospective cohort study of the Pediatric Health Information System database. SETTING: Forty-seven tertiary referral U.S. children’s hospitals. PATIENTS: Patients 5–18 years old with an underlying neuromuscular or genetic disorder admitted to the ICU following thoracic-lumbar spinal fusion for scoliosis, with hospital discharge between January 1, 2016, and December 31, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 6511 patients who met inclusion criteria, of which 438 (6.7%) had established preoperative tracheostomy and ventilator dependence. Three hundred seventy-two (5.7%) and 458 (7%) patients underwent postoperative IMV for 4–6 days and greater than or equal to 7 days, respectively. Chronic conditions associated with greater odds of greater than or equal to 4 days of postoperative IMV (as shown by adjusted odds ratio [aOR, 95% CI]), included diseases affecting the following systems: neurologic (aOR, 3.5; 95% CI, 2.5–5.0), respiratory (aOR, 2.8; 95% CI, 2.3–3.5), skin/subcutaneous tissue (aOR, 1.5; 95% CI, 1.2–2.1), hematologic (aOR, 1.4; 95% CI, 1.1–1.7), endocrine/metabolic (aOR, 1.3; 95% CI, 1.1–1.6), genitourinary (aOR, 1.3; 95% CI, 1.1–1.7), and cardiac (aOR, 1.3; 95% CI, 1.0–1.7). Established preoperative tracheostomy was associated with lower odds of greater than or equal to 4 days of postoperative IMV (aOR, 0.1; 95% CI, 0.02–0.3). New tracheostomy procedures were uncommon ( n = 43, 0.7%). Finally, there was substantial regional variation in postoperative IMV after spinal fusion, with patients in the Northeast vs. Midwest region having greater odds of greater than or equal to 4 days of postoperative IMV (aOR, 3.1; 95% CI, 1.9–5.0). CONCLUSIONS: One-in-eight children required greater than or equal to 4 days of IMV after spinal fusion. Chronic conditions affecting the neurologic, respiratory, skin/subcutaneous tissue, hematologic, endocrine/metabolic, genitourinary, and cardiac systems were associated with postoperative IMV. Further understanding of chronic conditions, clinical characteristics, and regional factors associated with duration of IMV may identify opportunities for improvements in care delivery.

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