• Rafael De la Garza Ramos, C Rory Goodwin, Taylor Purvis, Isaac O Karikari, Amer F Samdani, and Daniel M Sciubba.
• *Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland †Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York ‡Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina §Shriners Hospitals for Children, Philadelphia, Pennsylvania.
• Spine. 2016 Oct 6.

Study DesignRetrospective cohort study of a nationwide database.ObjectiveTo compare in-hospital outcomes for pediatric patients who underwent primary versus revision spinal fusion.Summary Of Background DataThere is limited data on outcomes after primary versus revision spinal fusion in children.MethodsData from the Nationwide Inpatient Sample from 2002 to 2011 was analyzed. Pediatric patients (age <18) who underwent ≥ 3 level spinal fusion were identified. Demographics, in-hospital complications, length of stay, and hospital charges were compared between primary and revision (re-fusion) procedures. All analyses were performed after application of discharge weights.ResultsData from 72,483 primary fusion and 2,042 revision fusion procedures (2.7%) were analyzed. Average length of stay was 7.9 days for the revision group and 6.6 for the primary group (p = 0.022). Average total charges were $135,644 and $142,029 for the revision and primary fusion groups, respectively (p = 0.252). The percentage of patients who developed at least one in-hospital complication was 16.7% in the revision group and 8.6% in the primary fusion group (p<0.001). Specific complications that were more common in the revision group were reintubation (4.3% vs. 2.3%, p = 0.008), hemorrhage/hematoma (5.0% vs. 2.5%, p = 0.001), wound complications (4.0% vs. 1.1%, p < 0.001), accidental vessel/nerve puncture (2.6% vs. 0.8%), p < 0.001), implant-related complications (5.3% vs. 0.4%, p < 0.001), and incidental durotomy (2.1% vs. 0.3%, p < 0.001). On multivariate analysis, revision procedures (OR 2.64; 95% CI, 1.93 - 3.59; p < 0.001), male sex (OR 1.73; 95% CI, 1.52 - 1.98; p < 0.001), and fusion of 8 or more spinal levels (OR 1.27; 95% CI, 1.09 - 1.47; p = 0.001) were risk factors for complication development.ConclusionIn this study, pediatric patients who underwent spinal re-fusion had significantly higher complication rates compared to patients who underwent primary fusion, consistent with previous investigations. Male patients and patients who underwent fusion of 8 or more spinal levels also had higher complication rates.Level Of Evidence3.

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