Impact of Navigation on 30-Day Outcomes for Pediatric Deformity Surgery   — The International Society for the Study of the Lumbar Spine
  1. Schedule
  2. Special Poster Session 1C. DEFORMITY, MUSCLE AND INSTABILITY
  3. Impact of Navigation on 30-Day Outcomes for Pediatric Deformity Surgery  

Impact of Navigation on 30-Day Outcomes for Pediatric Deformity Surgery   (#111)

Junho Song 1 , Austen Katz 1 , Vishal Sarwahi 1
  1. Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, United States

Introduction: Navigation has increasingly been used to treat degenerative disease, with improved radiographic accuracy and positive clinical outcomes1,2. However, short-term outcomes research on treating pediatric deformity with navigation is limited3. This is the first large-scale database study to compare short-term outcomes in pediatric deformity with and without navigation.

Methods: Deformity surgery patients were identified in the 2012-2018 pediatric-NSQIP datasets (CPT 22800-22804). Patients with severe preoperative comorbidities, infection, or anterior, revision, lesion, or nonelective surgery were excluded. Regression was used to compare readmission, reoperation, morbidity, and specific complications between navigation and conventional, and to control for predictors.

Results: 16,950 patients (356 with navigation) were included. Navigated cases had greater preoperative hematocrit (40.5 vs 39.9, p=0.005) and OR time (352 vs 284 min, p<0.001), but similar RVUs (58.4 vs 60.1) and fewer RVUs per minute (0.21 vs 0.23, p<0.001) (Table 1).

Navigation group had greater reoperation (6.2 vs 3.1%, p=0.001), morbidity (75.6 vs 67.5%, p=0.001), deep-wound infection (2.5 vs 0.8%, p=0.003), transfusion (73.6 vs 65.9%, p=0.002), and sepsis (2.2 vs 0.7%, p=0.007) rates. Readmission was similar (5.9 vs 3.9%, p=0.055). In multivariate analysis, navigation predicted reoperation (OR=1.920, p=0.019), deep-wound infection (OR=2.926, p=0.009), and sepsis (OR=3.192, p=0.010).

Obesity (OR=2.472), developmental delay (OR=1.926), OR time (OR=1.002), hospital stay (OR=1.040), and total RVUs (OR=1.005) predicted reoperation (p<0.001) (Table 2). Black race (OR=1.193, p=0.002), Hispanic ethnicity (OR=1.401, p<0.001), seizure (OR=1.384, p=0.004), OR time (OR=1.005, p<0.001) and total RVUs (OR=1.009, p<0.001) predicted morbidity. Female gender was protective of readmission (OR=0.787, p=0.021).

Conclusion: Navigation cases were longer and had fewer RVUs-per-minute. Navigation had 92% greater odds of reoperation and predicted deep wound infection and sepsis despite controlling for patient-related factors and case complexity. This is explained, in part, by greater OR time and transfusion. Site-related factors played the largest role in reoperation.

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  1. Flynn JM, Sakai DS. Improving safety in spinal deformity surgery: advances in navigation and neurologic monitoring. Eur Spine J. 2013 Mar;22 Suppl 2(Suppl 2):S131-7. doi: 10.1007/s00586-012-2360-6. Epub 2012 May 22. PMID: 22614688; PMCID: PMC3616474.
  2. Overley SC, Cho SK, Mehta AI, Arnold PM. Navigation and Robotics in Spinal Surgery: Where Are We Now? Neurosurgery. 2017 Mar 1;80(3S):S86-S99. doi: 10.1093/neuros/nyw077. PMID: 28350944.
  3. Baldwin KD, Kadiyala M, Talwar D, Sankar WN, Flynn JJM, Anari JB. Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform. 2021 Jul 12. doi: 10.1007/s43390-021-00385-5. Epub ahead of print. PMID: 34251607.
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