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Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa.

Authors
  • Wulff, Irene1
  • Duah, Henry Ofori1
  • Osei Tutu, Henry1
  • Ofori-Amankwah, Gerhard1
  • Yankey, Kwadwo Poku1
  • Owiredu, Mabel Adobea1
  • Bidemi Yahaya, Halima1
  • Akoto, Harry1
  • Oteng-Yeboah, Audrey1
  • Boachie-Adjei, Oheneba1
  • 1 FOCOS Orthopaedic Hospital, Accra, Ghana. , (Ghana)
Type
Published Article
Journal
Global Spine Journal
Publisher
SAGE Publications
Publication Date
Oct 01, 2021
Volume
11
Issue
8
Pages
1208–1214
Identifiers
DOI: 10.1177/2192568220942482
PMID: 32772734
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Retrospective review of consecutive series. This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m2, P = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, P = .87.), coronal Cobb angle (95° vs 88.5°, P = .43), preoperative forced vital capacity (45.3% vs 62.0%, P = .02), preoperative FEV1 (forced expiratory volume in 1 second) (41.9% vs 63.1%, P < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV1 (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, P = .013). The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV1 was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.

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