Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosis.

Background: Neuromuscular scoliosis (NMS) is associated with progressive restrictive lung disease and an increased risk of prolonged ventilation following surgery. This study reports the experiences of a single institution and evaluates whether preoperative pulmonary function tests (PFT) can predict the development of postoperative pulmonary complications.

Methods: Correlations between preoperative PFT (forced expired volume in 1 s, FEV(1); forced vital capacity, FVC) findings and postoperative pulmonary complications were searched for among 74 NMS patients who underwent surgical correction at our medical center from 2002 to 2008.

Results: Thirty-seven patients (50%) developed a pulmonary complication. The independent factors found to contribute to the development of a pulmonary complication were: FEV(1) <40% of the predicted value (P = 0.007), FVC <39.5% of the predicted value (P = 0.005), a larger Cobb angle (>69°) (P = 0.002), and older age (>16.5 years) (P = 0.027). Of these 37 patients, 6 needed postoperative ventilation. PFT findings found to be independently associated with the need for postoperative ventilation were: FEV(1) <40% of the predicted value (P = 0.017) and FVC <39.5% of the predicted value (P = 0.015).

Conclusions: NMS patients with a preoperative FVC of <39.5% of the predicted value, an FEV(1) <40% of the predicted value, a Cobb angle of >69°, or age >16.5 years were found to be more likely to develop a postoperative pulmonary complication.