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, FEV1; 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: FEV₁ <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: FEV₁ <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 FEV₁ <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.