Background <p>Early (within 30&#xa0;days) postoperative complications following pediatric scoliosis surgery continue to be of clinical importance; however, reported risk factors demonstrate inconsistency across various studies. We conducted a systematic review and meta-analysis to quantify patient- and procedure-related predictors of 30-day postoperative outcomes complications.</p> Methods <p>A systematic search of PubMed, Embase, Scopus, and Web of Science identified observational studies reporting risk factors for 30-day postoperative complications following scoliosis surgery. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects models. Heterogeneity was assessed with the <i>I</i>² statistic.</p> Results <p>Ten observational studies comprising 113,082 patients met the inclusion criteria; nine reported adjusted estimates. Osteotomy was significantly associated with increased risk (OR = 1.40; 95% CI 1.25–1.55; <i>I</i>² = 0%), as was pelvic fixation (OR = 1.65; 95% CI 1.07–2.55; <i>I</i>² = 0%), with no observed heterogeneity across studies. In contrast, multiple medical and patient-related risk factors including cardiopulmonary, hematologic and metabolic comorbidities were not significantly associated with postoperative morbidity, although point estimates suggested a directionally elevated risk and were characterized by wide confidence intervals. Male sex and neuromuscular disorders were also not associated with a significant increase in risk.</p> Conclusions <p>Among the evaluated factors, complex surgical techniques involving osteotomy and pelvic fixation were the most consistent predictors of early postoperative complications within the contemporary literature. Preoperative patient comorbidities showed variable, generally non-significant associations, underscoring the need for standardized risk definitions and prospective multicenter studies to better predict outcomes in the early postoperative period.</p>