Mortality after spinal fusion in children with cerebral palsy and cerebral‐palsy‐like conditions: A 30‐year follow‐up study

Aim To report survival probability of a large cohort of children with cerebral palsy (CP) after spinal fusion. Method All children with CP who had spinal fusion between 1988 and 2018 at the reporting facility were reviewed for survival. Death records of the institutional CP database, institutional electronic medical records, publicly available obituaries, and the National Death Index through the US Centers for Disease Control were searched. Survival probabilities with different surgical eras, comorbidities, ages, and curve severities were compared using Kaplan–Meier curves. Results A total of 787 children (402 females, 385 males) had spinal fusion at a mean age of 14 years 1 month (standard deviation 3 years 2 months). The 30‐year estimated survival was approximately 30%. Survival decreased for children who had spinal fusion at younger ages, longer postoperative hospital stays, longer postoperative intensive care unit stays, gastrostomy tubes, and pulmonary comorbidities. Interpretation Children with CP who required spinal fusions had reduced long‐term survival compared with an age‐matched typically developing cohort; however, a substantial number survived 20 to 30 years after the surgery. This study had no comparison group of children with CP scoliosis; therefore, we do not know whether correction of scoliosis affected their survival. A total of 787 children had spinal fusion at mean age of 14 years 1 month (6–20 years range). Survival probability for the entire group was 30% at age 45 years and 30 years postoperative. Survival was decreased for children who had spinal fusion with longer postoperative hospital stays, presence of a gastrostomy tubes, and pulmonary comorbidities. Video Podcast: https://youtu.be/V‐J72tfasp4 This original article is commented on by Day and Reynolds on pages 1135–1136 of this issue.