Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012-2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28-31 weeks), and moderate-to-late (32-36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations.

The authors declare no conflict of interest. M.C.—Stock or stock Options—Johnson & Johnson, Roche, Sanofi-Aventis, Shire. V.L.—Paid consultant—Alphatec Spine DePuy, Stryker; Paid presenter or speaker—Johnson & Johnson Company; Editorial or governing board—European Spine Journal; Paid con-sultant—Globus Medical; Board or committee member—International Spine Study Group; IP roy-alties—NuVasive; Board or committee member—Scoliosis Research Society. C.B.P.—Paid presenter or speaker—DePuy, A Johnson & Johnson Company, Ethicon. P.G.P.—grant funding from CSRS, speaker and consultant honoraria from Globus Medical, Medicrea, SpineWave, and Zimmer, and other financial support from Allosource. F.J.S.—grant funding from DePuy, NuVasive, Allosource, K2M, Medtronic, and Si Bone, speaker and consultant honoraria from Globus Medical, Mainstay Medical, Medtronic, and ZimmerBiomet, royalties from Medicrea, Medtronic, and Zimmer, and serves on boards or committees for SRS, Spine Deformity, and ISSG. For the remaining authors, there were no disclosures to report.