Pediatric scoliosis surgery--is postoperative intensive care unit admission really necessary?

Background It is common practice for patients to be admitted to the intensive care unit following scoliosis surgery, because of the prolonged anesthesia, the need for efficient pain control and the known immediate postoperative complications. However, this may be unnecessary in many patients. Purpose We aimed to establish possible associations between pre- and perioperative parameters and early postoperative complication rates, in particular the need for prolonged mechanical ventilation (>1day), and the presence of major complications in children undergoing primary spinal fusion by thoracolumbar spine instrumentation. Methods We conducted a retrospective review of children undergoing primary scoliosis surgery at a university-affiliated general hospital from 1998 to 2008. Results Surgical approaches were as follows: anterior spinal fusion, posterior spinal fusion, and combined anterior and posterior fusion. Prior to mid-2005, anesthesia included morphine; thereafter, remifentanil was used. Major complications correlated significantly with neuromuscular scoliosis (NMS) (OR, 4.94; 95% CI, 1.0224.05), comorbidity conditions (OR, 3.47; 95% CI, 1.1610.42), and anterior or combined fusion (OR, 7.81; 95% CI, 2.1228.57). Late extubation correlated significantly with NMS (OR, 31.25; 95% CI, 1.06100.00) and morphine use during anesthesia (OR, 17.91; 95% CI, 1.44222.9). Conclusions Relatively young, healthy idiopathic scoliosis children receiving intraoperative remifentanil sedation and undergoing posterior fusion can be successfully managed in regular wards in the immediate postoperative period. However, intensive care unit admission should be considered in NMS patients, patients with comorbidity conditions, those undergoing anterior or combined spinal fusion, and patients whose anesthesia involves long-acting opioids.