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Purpose <p>Longer operative time has been associated with increased postoperative complications in various surgical specialties. This has not been studied in pediatric idiopathic scoliosis surgery. The purpose of this study was to study the relationship between operative time and rates of adverse outcomes in pediatric idiopathic scoliosis surgery.</p> Methods <p>This was a retrospective cohort study using the NSQIP pediatric database years 2016–2022. Patients were included in this study if they were under 18&#xa0;years of age and received posterior spinal fusion for idiopathic scoliosis. Revision surgery and anterior approaches were excluded from the study. The primary outcome was the rate of adverse events. Secondary outcomes were surgical site infection, allogeneic transfusion, and length of stay. Patient and surgical characteristics were described using descriptive statistics. Logistic regression analyses were performed to determine the association between operative time and adverse event, surgical site infection, allogeneic transfusion, and postoperative neurological deficit. Linear regression analysis was performed to determine the association between operative time and length of stay. Adverse event rate, surgical site infection rate, transfusion rate, and mean length of stay were stratified by operative time (&lt; 3&#xa0;h, 3–5&#xa0;h, 5–7&#xa0;h, 7–9&#xa0;h, &gt; 9&#xa0;h).</p> Result <p>There were 22,888 patients included in this study. Mean age was 14.4&#xa0;years. Mean operative time was 4.5&#xa0;h. The rate of adverse event increased with operative time (&lt; 3&#xa0;h: 0.5%; &gt; 9&#xa0;h: 3.2%). The rate of surgical site infection increased with operative time (&lt; 3&#xa0;h: 0.2%; &gt; 9&#xa0;h: 2.3%). The rate of allogeneic transfusion increased with operative time (&lt; 3&#xa0;h: 4.9%; &gt; 9&#xa0;h: 32.9%). The rate of postoperative neurological deficit increased with operative time (&lt; 3&#xa0;h: 0.2%; &gt; 9&#xa0;h: 5.0%). The mean length of stay increased with operative time (&lt; 3&#xa0;h: 3.2; &gt; 9&#xa0;h: 6.2). In adjusted regression analyses, controlling for number of surgical levels, three-column osteotomies, and pelvic instrumentation, each operative hour was associated with higher odds of adverse event (OR 1.18, <i>p</i> &lt; 0.001), higher odds of surgical site infection (OR 1.14, <i>p</i> = 0.012), higher odds of allogeneic transfusion (OR = 1.41, <i>p</i> &lt; 0.001), higher odds of postoperative neurological deficit (OR = 1.45, <i>p</i> &lt; 0.001), and longer length of stay (<i>B</i> = 0.26, <i>p</i> &lt; 0.001).</p> Conclusion <p>Increasing operative time is associated with higher risk of adverse event, surgical site infection, transfusion, and longer length of stay. Surgical strategies that reduce operative time should be utilized to optimize outcomes.</p>

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Longer operative time is associated with higher risk of adverse outcomes in pediatric idiopathic scoliosis surgery

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Vivien Chan,
  • Andy M. Liu,
  • Adeesya Gausper,
  • Suhas Etigunta,
  • Andrew Chan-Tai-Kong,
  • Kenneth D. Illingworth,
  • Firoz Miyaji,
  • David L. Skaggs

摘要

Purpose

Longer operative time has been associated with increased postoperative complications in various surgical specialties. This has not been studied in pediatric idiopathic scoliosis surgery. The purpose of this study was to study the relationship between operative time and rates of adverse outcomes in pediatric idiopathic scoliosis surgery.

Methods

This was a retrospective cohort study using the NSQIP pediatric database years 2016–2022. Patients were included in this study if they were under 18 years of age and received posterior spinal fusion for idiopathic scoliosis. Revision surgery and anterior approaches were excluded from the study. The primary outcome was the rate of adverse events. Secondary outcomes were surgical site infection, allogeneic transfusion, and length of stay. Patient and surgical characteristics were described using descriptive statistics. Logistic regression analyses were performed to determine the association between operative time and adverse event, surgical site infection, allogeneic transfusion, and postoperative neurological deficit. Linear regression analysis was performed to determine the association between operative time and length of stay. Adverse event rate, surgical site infection rate, transfusion rate, and mean length of stay were stratified by operative time (< 3 h, 3–5 h, 5–7 h, 7–9 h, > 9 h).

Result

There were 22,888 patients included in this study. Mean age was 14.4 years. Mean operative time was 4.5 h. The rate of adverse event increased with operative time (< 3 h: 0.5%; > 9 h: 3.2%). The rate of surgical site infection increased with operative time (< 3 h: 0.2%; > 9 h: 2.3%). The rate of allogeneic transfusion increased with operative time (< 3 h: 4.9%; > 9 h: 32.9%). The rate of postoperative neurological deficit increased with operative time (< 3 h: 0.2%; > 9 h: 5.0%). The mean length of stay increased with operative time (< 3 h: 3.2; > 9 h: 6.2). In adjusted regression analyses, controlling for number of surgical levels, three-column osteotomies, and pelvic instrumentation, each operative hour was associated with higher odds of adverse event (OR 1.18, p < 0.001), higher odds of surgical site infection (OR 1.14, p = 0.012), higher odds of allogeneic transfusion (OR = 1.41, p < 0.001), higher odds of postoperative neurological deficit (OR = 1.45, p < 0.001), and longer length of stay (B = 0.26, p < 0.001).

Conclusion

Increasing operative time is associated with higher risk of adverse event, surgical site infection, transfusion, and longer length of stay. Surgical strategies that reduce operative time should be utilized to optimize outcomes.