The complication trends of pediatric spinal deformity surgery in Japan - The Japanese Scoliosis Society Morbidity and Mortality survey from 2012 to 2017

Abstract

Background: The Japanese Scoliosis Society Morbidity & Mortality Committee performed a longitudinal nationwide complication survey of spinal deformity surgery from 2012 to 2017. The present study aimed to analyze the survey results and report the complication trends of pediatric spinal deformity surgery in Japan.

Methods: All Japanese Scoliosis Society members were invited to participate in the survey. Diagnoses were grouped into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, other types of scoliosis, and pediatric kyphosis. Complications were grouped into death, blindness, neurological deficits (motor/sensory), infection, massive bleeding, hematoma, pneumonia, cardiac failure, deep vein thrombosis/pulmonary embolism, gastrointestinal perforation, and instrumentation failure.

Results: The surveys were performed in 2012, 2014, and 2017. The overall complication rate decreased from 10.7% in 2012 to 8.1% in 2017. In particular, the complication rate in patients with idiopathic scoliosis decreased from 8.8% in 2012 to 4.0% in 2017. The complication rate of patients with neuromuscular scoliosis and kyphosis remained high. The rate of neurological deficits, especially in motor deficits, significantly decreased from 2.0% in 2012 to 0.7% in 2017, and tended to be highest in patients with kyphosis. The rate of massive bleeding was significantly decreased from 3.3% in 2012 to 0.8% in 2017, especially in patients with neuromuscular scoliosis (12.2-4.4%). However, patients with neuromuscular scoliosis had a high rate of postoperative pneumonia (3.7%, 2.6%, and 5.1%, respectively). The rate of instrumentation failure was also high (2.1%, 1.5%, and 2.2%, respectively), especially in patients with early onset idiopathic, congenital and other types of scoliosis.

Conclusions: The overall surgical complication rates in pediatric patients decreased due to decreased rates of neurological deficits and massive bleeding, especially in patients with idiopathic scoliosis. However, the complication rates remain high in patients with neuromuscular scoliosis and kyphosis.