1525. Congenital and Idiopathic Early Onset Scoliosis: A Comparison of Presenting Comorbidity Profiles
Authors: Peter Gust Passias; Frank Segreto, BS; Samantha Horn, BA; Cole Bortz, BA; Bassel Diebo, MD; Aaron Hockley, MD; Anthony Petrizzo, MD; Aaron Buckland, MBBS; Michael Gerling, MD; Thomas Errico, MD (Brooklyn Heights, NY)
Significant comorbidity in early onset scoliosis (EOS) patients often complicates management decision-making. EOS derived through congenital or idiopathic etiologies intuitively may present with different comorbidity profiles and peri-operative risk, although these profiles have not been adequately described.
The KID database was queried for ICD-9 codes pertaining to congenital (C-EOS) and idiopathic (I-EOS) scoliosis patients ≤ 10 y/o from 2003, 2006, 2009, and 2012. Demographics, incidence and comorbidity profiles were assessed. Comorbidity profiles were stratified by general body systems (neurological, musculoskeletal, pulmonary, cardiovascular, renal). K-means cluster, cross-tabulations, descriptive analysis, and means comparisons were used to quantify and evaluate relationships between comorbidity clusters and scoliosis groupings.
7,310 C-EOS and 18,438 I-EOS patients were included. C-EOS patients were younger (3.72 vs 4.59 y/o, P<0.001), more male (52.6% vs 50.7%, P<0.001) relative to I-EOS. C-EOS patients had higher overall comorbidity rates (95.1% vs 86.5%, P<0.001), despite lower Charlson index scores (0.3770 vs 0.7495, P<0.001). C-EOS patients presented with 91.3% musculoskeletal, 47.7% pulmonary, 28.7% neurological, 22.2% Cardiovascular, 15.1% renal comorbidities. I-EOS patients presented with 57.9% pulmonary, 49.9% neurological, 32.5% musculoskeletal, 17.3% cardiovascular, 10.8% renal comorbidities. Top general comorbidity clusters: Cluster analysis identified concurrent pulmonary+neurologic for C-EOS (24.6%) and I (44.2%) patients. C-EOS patients also exhibited concurrent Renal+Cardiovascular (6.0%). I-EOS patients exhibited renal (10.8%) with concurrent cardiovascular+musculoskeletal (30.2%). Top specific comorbidity clusters: Cluster analysis identified ostium secundum atrial septal defect in C-EOS (16%) and I-EOS (14%) to significantly co-occur with patent ductus arteriosus (35.7% vs 32.6%) or ventricular septal defect (24.3% vs 27.1%).
Our analysis describes relatively synonymous comorbidity clusters for both Idiopathic and Congenital EOS patients. Despite similar clustering profiles, Idiopathic patients were of equal or greater risk for increased comorbidity severity. Appropriate testing (renal ultrasound, echocardiogram, etc) should be utilized in preoperative optimization for EOS, regardless of deformity etiology.