(1192) Postoperative Mechanical Ventilation for Children With Medical Complexity Undergoing Spinal Fusion

Introduction: Preparing children with medical complexity (CMC) for spinal instrumentation is challenging, due to multiple comorbidities affecting their perioperative health and respiratory function. Understanding factors associated with prolonged postoperative invasive mechanical ventilation (IMV) is important to inform risk assessments and systems provision. The aims of this study were to characterize the duration of postoperative IMV and to assess factors associated with 4 or more days of postoperative IMV in CMC undergoing spinal fusion.

Methods: Retrospective cohort analysis of patients aged 5-to-18 years in the Pediatric Health Information System database with an underlying complex, chronic neuromuscular or genetic disorder admitted to the ICU following thoracic-lumbar spinal fusion for scoliosis in 47 children’s hospitals with hospital discharge between Jan 1, 2016 and Dec 31, 2021. We assessed the type of chronic medical comorbidities using the AHRQ Chronic Condition Indicator (CCI) system. Generalized estimating equations were used to assess factors associated with prolonged IMV, accounting for hospital-level clustering.

Results: There were 6,511 patients who met inclusion criteria. Postoperative IMV duration of 4-6 days and 7 or more days was required for 372 (5.7%) and 458 (7.0%) patients, respectively. CCIs associated with 4 or more days of postoperative IMV included diseases affecting the following systems: neurologic (adjusted OR: 3.54; 95% CI: 2.53-4.97), respiratory (adjusted OR: 2.83; 95% CI: 2.31-3.47), skin/subcutaneous tissue (adjusted OR: 1.54; 95% CI: 1.16-2.06), hematologic (adjusted OR: 1.36; 95% CI: 1.11-1.68), genitourinary (adjusted OR: 1.33; 95% CI: 1.05-1.69), and cardiac (adjusted OR: 1.3; 95% CI: 1.01-1.68 ). Established tracheostomy was inversely associated with 4 or more days of postoperative IMV (adjusted OR: 0.07; 95% CI: 0.02-0.31). New tracheostomy procedures were uncommon (n=43, 0.7%).

Conclusions: One-in-eight CMC required 4 or more days of IMV after spinal fusion. CCIs affecting the neurologic, respiratory, skin/subcutaneous tissue, hematologic, genitourinary, and cardiac systems were associated with duration of postoperative IMV. Further understanding of chronic conditions associated with IMV may identify opportunities for improvements in care delivery.