Risk Factors for Postoperative Pulmonary Complications Following Posterior Spinal Fusion in Adolescent Scoliosis: A Retrospective Cohort Study.

OBJECTIVES:Scoliosis is a prevalent spinal deformity that severely impacts the physical and psychological well-being of adolescents and often requires surgical correction. This study aimed to investigate the risk factors for postoperative pulmonary complications (PPCs) following posterior spinal fusion in adolescent scoliosis, with a specific focus on evaluating the predictive value of preoperative forced vital capacity (FVC) and etiological classification. METHODS:This retrospective cohort study enrolled adolescents who underwent posterior spinal fusion for scoliosis correction at Peking Union Medical College Hospital between January 2018 and December 2022. The baseline demographic, clinical, and perioperative variables were collected. The primary endpoint was the occurrence of PPCs prior to hospital discharge. Univariate and multivariable binary logistic regression analyses were conducted to identify independent risk factors. RESULTS:A total of 1,234 patients were included, of whom 29 (2.35%) developed PPCs and 1,205 did not. Univariate analysis revealed that 12 variables, including non-idiopathic scoliosis, a larger main thoracic curve, a decreased FVC% predicted, and increased perioperative blood transfusions, were significantly associated with PPCs (P < 0.05). Multivariable logistic regression model showed that non-idiopathic scoliosis emerged as the sole independent risk factor for PPCs [adjusted odds ratio (OR) = 5.478, 95% confidence interval: 2.017-19.148, P = 0.002]. Preoperative FVC% predicted (adjusted OR = 0.993, P = 0.497) and main thoracic curve (adjusted OR = 1.002, P = 0.736) did not demonstrate independent predictive value. CONCLUSIONS:Non-idiopathic scoliosis, rather than preoperative pulmonary function or curve severity, is an independent risk factor for PPCs following posterior spinal fusion in adolescents. During perioperative respiratory risk assessment, particular emphasis should be placed on the etiological classification of these patients.