Does neurofibromatosis 1 status impact outcomes for pediatric/young adults undergoing spinal fusion?

ABSTRACT

BACKGROUND: Although spinal deformities are common in patients with neurofibromatosis type 1 (NF1), there is a paucity of data as to how this impacts outcomes of spinal fusion surgery in pediatric/young adult patients. METHODS: Using the Nationwide Inpatient Sample (2005-2014) for all patients undergoing spinal fusion ≤26 years of age, we compared the following factors demographics, comorbidities, and perioperative variables (e.g., between NF1 vs. non-NF1, and between NF1 and propensity score (PS)-matched non- NF1 spinal fusion patients) using univariate hypothesis tests and multivariate regression analyses. Our main interest focused on length of stay, complication rates, adverse postoperative events, and incidence of nonroutine discharges. RESULTS: In this study, 238 (0.92%) NF1 spine patients were compared to 25,558 (99.08%) non-NF1 spine patients. NF1 fusion patients were younger, included fewer females, and were more likely to be on Medicaid. Perioperatively, NF1 patients underwent more anterior approaches, had more vertebrae fused, required more transfusions, had a longer length of stay (LOS), and were less likely to be discharged home. However, after PS- matching, all differences between NF1 and non-NF1 groups disappeared were similar (P > 0.05). In PS-matched multivariate analyses, NF1-status was not a significant independent predictor of length of stay or nonroutine discharge disposition. CONCLUSION: NF1-status was, therefore, not an independent predictor of complications, adverse postoperative events, longer LOS, or nonroutine hospital discharge in this cohort analysis. Further prospective studies are necessary to understand how outcomes in patients with NF1 compare to non-NF1 pediatric and young adult patients.