Commentary on “Predictors of postoperative systemic inflammatory response syndrome after scoliosis surgery in adolescents with cerebral palsy: A retrospective analysis”

Sandacharam et al. investigated the incidence and predictive factors for developing systemic inflammatory response syndrome (SIRS) following posterior spinal fusion (PSF) for patients with neuromuscular scoliosis [1]. This was to follow up on their observation that SIRS occurred with a higher than recognized incidence in this population.

SIRS is defined as an exaggerated defense response to a noxious stressor, such as infection, trauma, or surgery. More specifically, its occurrence was noted based on core temperature >38.5°C or <36°C, tachycardia defined as a mean heart rate more than two standard deviations above normal for age, mean respiratory rate more than two standard deviations above normal for age or mechanical ventilation for an acute pulmonary process, and leukocyte count elevation or depressed for age or >10% immature neutrophils.

Poorly controlled SIRS can lead to a dysregulation of both pro- and anti-inflammatory cascades that eventually cause severe immunosuppression and predispose to secondary/nosocomial infections. If not properly managed, this can develop into sepsis, septic shock, and multiorgan dysfunction syndrome (MODS).

The authors retrospectively evaluated patients from 2017-2019 who underwent PSF for neuromuscular scoliosis and excluded patients with idiopathic scoliosis and scoliosis due to osteogenesis imperfecta and with tracheostomy. The incidence and predictive factors of SIRS within 48 hours of surgery were assessed by univariate and multivariate analyses.

Of 77 patients, criteria for meeting the definition of SIRS were identified for 34 (44%). No statistically significant differences were found in the demographics and other preoperative variables for those who did versus did not develop SIRS. These included: degree of scoliosis, surgery type, feed status, seizure status, and motor function determined by gross motor function classification system (GMFCS) scores.

Intraoperatively, there were no significant differences in surgery time, blood loss, and crystalloid administration. By univariate analyses, those that developed SIRS received greater total blood products and remained intubated postoperatively for significantly longer. By multivariate analyses, those who were not extubated at the end of surgery were at nearly 7.5-fold increased odds of developing SIRS.

Overall, the high incidence of postoperative SIRS for the studied patient population is of significant note. Multivariate analysis revealed that remaining intubated at the end of the case was the sole factor independently predictive of developing SIRS. This is most probably contributed by multiple patient factors and surgical variables, but it is a simple independent marker that can be used to identify those at greatest risk for SIRS.

The findings presented from the reviewed study are pertinent to helping identify patients with SIRS and potentially facilitating earlier intervention of related findings for the population studied. Sandacharam and team astutely recognized and evaluated a trend that they were seeing in their patients and provide clinically relevant information for caring for patients with neuromuscular scoliosis undergoing posterior spinal fusion.

Declaration of Competing Interests

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