Risk Factors for Transfusion and Infection Following Pediatric Scoliosis Surgery: Insights from a Latin American Retrospective Cohort

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Methods A retrospective analytical cohort study was conducted on patients under 18 years who underwent posterior scoliosis correction surgery at a single referral centre (2014–2022). Exclusion criteria included spinal trauma, oncologic diagnoses, or multiple surgeries. Primary outcomes were perioperative blood transfusion and postoperative infection within one year. Odds ratios were calculated, and multivariate logistic regression identified independent risk factors. Results Among 427 patients, 34% required transfusion and 8.2% developed infection. Independent risk factors of transfusion included scoliosis type (neuromuscular or syndromic), Cobb angle (70°–90°), ASA score (3–4), and intraoperative blood loss ≥ 40% of blood volume. Infection was independently associated with ASA 3–4 and Cobb angles ≥ 90°. Transfusion accumulated risk ranged from 9.6% (no factors) to 100% (four factors), while infection risk rose from 4.9–72.7% (two factors). Conclusions Preoperative Cobb angle ≥ 90° and ASA 3–4 were independent risk factors of both transfusion and infection. Neuromuscular or Syndromic types of scoliosis and significant intraoperative bleeding were associated with transfusion risk. The higher the number of factors, the higher the cumulative risk of transfusion or infection. These findings offer valuable insights for preoperative risk stratification, enabling more effective planning in complex scoliosis cases. Scoliosis Fusion Spinal Complications Blood transfusion Infection Pediatric Figures Figure 1 INTRODUCTION Blood transfusions and infections are relatively common outcomes following spinal surgeries[ 1 ]. These outcomes can increase treatment costs and contribute to more challenging patient care, especially for patients with comorbidities[ 2 , 3 ]. Identifying risk factors for these outcomes is required for effective preoperative planning in spinal surgery. Key risk factors for blood transfusions include a lower body mass index (BMI), lower preoperative haemoglobin levels, and greater fused spinal levels [ 4 – 6 ]. Comorbidities are often noted as significant risk factors for infections[ 7 , 8 ]. Notably, the risk factors for surgical site infections (SSI) and delayed infections overlap with those for blood transfusions. Despite existing evidence, research on these risk factors in pediatric spinal surgery is to some extent limited, particularly in non-Caucasic populations[ 9 ]. Local healthcare barriers in Colombia such as delayed access to specialised care and inequality in access [ 10 ] may influence outcomes. While major population differences cannot be assumed, the lack of local data warrants further investigation.Moreover, the cumulative effect of risk factors in scoliosis surgery in pediatric populations remains a relatively unexplored area[ 11 , 12 ]. This study aims to identify risk factors for perioperative blood transfusion and postoperative infection following scoliosis correction surgery in a Latin American pediatric population. It will also quantify the cumulative risk for each outcome based on the number of coexisting factors, providing clinically useful data for preoperative risk stratification and planning in complex scoliosis cases. METHODS Study design and population: A retrospective analytical study was conducted at a single referral center in Latin America between January 1, 2014, and December 13, 2022. The study included 427 (Fig. 1 ) patients under 18 years old. Inclusion criteria were being younger than 18 and having undergone a scoliosis correction surgery (posterior instrumentation) at a single surgical time. There was no specific cutoff value requirement for the number of instrumented vertebral levels, and all cases, including those with pelvic fixation, were eligible. Patients with trauma, oncological pathology, multiple surgeries, or no information on transfusion or infection were excluded. The study adheres to the STROBE guidelines for reporting observational studies. The patients were divided into two groups based on intraoperative transfusion requirement or infection during the first year postoperatively. Baseline patient and operative characteristics were evaluated, including age, sex, preoperative and postoperative haemoglobin, body mass index, and ASA class. All data were entered and securely stored using a secure electronic data capture platform. All surgeries were performed by three senior spine surgeons with over 10 years of experience in treating deformities of the spine. The total number of patients undergoing scoliosis surgery during the study period, as well as the number and reasons for exclusions, are detailed in Fig. 1 . Sample size calculation The sample size for both outcomes was calculated using a formula for estimating proportions in a population, ensuring 80% statistical power and a 5% alpha error for both procedures. For the infection outcome, an anticipated frequency of 2.82%, as reported in the scientific evidence[ 13 ], was used, which resulted in a sample size of 29 patients. For the transfusion outcome, an anticipated frequency of 32.8%, also based on the scientific evidence[ 5 ], led to a sample size of 229 patients. Ethical Considerations This study was approved by the institutional ethics committee. It adhered to ethical principles from the Declaration of Helsinki and local regulatory guidelines. Patient-informed consent was not required due to its retrospective nature. Outcomes: Infection : Surgical site infections (SSIs) were defined using the CDC/NHSN criteria[ 14 ], which classify infections into three categories: superficial incisional, deep incisional, or organ/space based on different parameters such as depth, purulent drainage, positive cultures, or intraoperative findings. We extended the monitoring period to 12 months postoperatively to document late infections, even though standard CDC guidelines recommend a 30-day supervision window ensuring a more comprehensive assessment of the outcome.The treating team verified all SSIs following institutional infection control procedures aligned with CDC/NHSN definitions. Antibiotic management was individualized for each patient based on intraoperative culture results. Blood transfusion Clinical criteria based on established transfusion guidelines were used to define which patients required perioperative transfusion (up to 24 hours after surgery). In general, patients with haemoglobin levels below 8 g/dl were transfused, particularly those with comorbidities, high ASA scores, neuromuscular pathology, significant intraoperative bleeding and haemodynamic instability. Depending on the patient profile (risk factors and comorbidities), the cut-off point could vary. This approach is in line with the literature[ 15 , 16 ], which generally supports restrictive transfusion protocols, where transfusion of blood products is allowed for patients with haemoglobin levels below 7g/dl with haemodynamic stability. Indications for transfusion were extracted from medical records and intraoperative anaesthesia reports. Tranexamic acid was routinely used as part of the institutional blood preservation protocol. No other blood saving techniques, such as intraoperative cell salvage (cell saver) among others, were utilized during surgery. Data Analyses: Bivariate analysis Data distribution was evaluated using the Shapiro‒Wilk test. Continuous variables were compared with the Mann‒Whitney U-tests if they were presented as medians or with Student's t-tests if they were presented as means. Categorical variables were compared using the chi-squared or Fisher's exact tests when the expected cell frequencies were less than 5. P values less than .05 were considered statistically significant. Multivariate logistic regression All types of scoliosis (congenital, idiopathic, neuromuscular, and syndromic) were analyzed together to ensure adequate sample size and statistical power. The type of scoliosis was incorporated as an independent variable in the multivariate logistic regression models, allowing both the assessment of its direct association with transfusion and infection risk and the control of its potential confounding effect. The study explored the potential association between risk factors like Cobb angle, ASA score, type of scoliosis, and blood volume loss with postoperative infection or intraoperative blood transfusion. Odds ratio analyses were conducted with 95% confidence intervals. Multivariable logistic regressions were constructed using variables that could act as confounders for transfusion requirement (Type of scoliosis, body mass index (BMI), ASA score, percentage of blood volume lost, and Cobb angle) and infection (type of scoliosis, body mass index (BMI), ASA score, Cobb angle, percentage of blood volume lost and transfusion requirement.). Variables with P < .05 were allowed to remain in the regressions (Stepwise selection method).The evaluation of the logistic regressions was analysed using Hosmer‒Lemeshow Chi-squared tests, and the Bayesian Criterion Information data were used to choose the best logistic regression model per the parsimony principle. A receiver operating characteristics curve analysis was performed to evaluate the logistic regression's performance, and the area under the curve was calculated. All analyses were performed in RStudio software, version 2023.12.1 + 402. Accumulated risk of transfusion or infectión A new variable was created to define the number of risk factors and a exploratory stratified analysis was performed showing the observed frequency of transfusion and postoperative infection according to the cumulative presence of risk factors identified as significant in the multivariate model. This analysis is not a predictive model, as it does not meet all the criteria of the TRIPOD checklists [ 17 ]. RESULTS Patient sociodemographic Most patients were female (67.2%), and the mean age was 14 years. Idiopathic scoliosis was the most prevalent type (56.9%). Most patients were ASA I-II (88.3%), with pre-surgical measures of a mean Cobb angle of 54.7 and a haemoglobin value of 14.7. Thirty-four point six per cent of the cohort was transfused, and 8.2% developed an infection. Further, sociodemographic characteristics are presented in Table 1 . The characteristics of patients, stratified by infection and transfusion requirement, are presented in Tables 2 and 3 . Multivariate Analysis of Risk Factors for Infection and transfusion after Surgery : Table 4 presents the multivariate analysis of risk factors for infection and transfusion as adjusted Odds Ratios (ORs) and Confidence Intervals (CIs). For transfusion risk, patients with neuromuscular and syndromic types of scoliosis had significantly higher odds of requiring transfusion, with adjusted ORs of 3.551 (95% CI: 1.857–6.791, P < .001) and 3.492 (95% CI: 1.074–11.347, P .038), respectively. Pre-surgical Cobb angles between 70–90° and ASA scores of 3–4 were also associated with increased transfusion risk, with adjusted ORs of 2.295 (95% CI: 1.071–4.915, P .032) and 2.928 (95% CI: 1.255–6.830, P .0129). The highest transfusion risk ocurred in patients with a bleeding percentage per blood volume greater than 40% with an adjusted OR of 13.452 (95% CI: 7.830–19.960, P .004). Regarding infection risk, an ASA score of 3–4 significantly increased infection odds, with an OR of 8.108 (95% CI: 3.093–21.256, P < .001), as did a pre-surgical Cobb angle ≥ 90°, with an OR of 5.919 (95% CI: 1.755–19.960, P .004). Logistic regression model for transfusion showed a non-significant Hosmer and Lemeshow goodness-of-fit test (P = 0.977) and an area under the curve (AUC) of 0.852. The model for infection showed a Hosmer and Lemeshow P = 0.958 and an AUC of 0.752. Accumulated risk of transfusion or infection by Number of Positive Factors The accumulated risk of transfusion increases from 9.6% when there are no risk factors to 100% when all four risk factors are present. Similarly, the accumulated risk of infection rises from 4.9% when there are no risk factors to 72.7% when both risk factors are present ( Table 5 ). DISCUSSION In our study, 34.6% of patients required perioperative transfusions and 8.2% developed infections. Risk factors for transfusion included the type of scoliosis (syndromic or neuromuscular), presurgical Cobb angle of 70–90°, ASA score of 3–4, and a bleeding volume > 40%. For infections, the highest risks were associated with an ASA score of 3–4 and a Cobb angle of 90° or greater. Finally, the accumulated risk of transfusion increases from 9.6% with no risk factors to 100% when all four are present, while the accumulated risk of infection rises from 4.9% without factors to 72.7% with both present. Infection rates following adolescent idiopathic scoliosis (AIS) correction surgery range between 0.71% and 4.7% [ 18 , 19 ]. In contrast, Sharma et al. found an 11% infection rate in neuromuscular scoliosis patients [ 20 ]. Although our overall (the sum of infection cases in all types of scoliosis ) infection rate is 8.2% (Table 1 ), our findings are similar to those reported in the literature when it comes to the percentage of infection according to scoliosis type, being 5.3% for AIS and 13.68% for neuromuscular scoliosis (Table 3 ). There is a lack of high-quality studies on risk factors for postoperative infection in pediatric scoliosis correction surgery. A systematic review identified five risk factors in pediatric scoliosis surgery: inappropriate antibiotic use (P = .001), neuromuscular scoliosis (P = .014), levels of instrumentation (P = .023), increased hospital stay days (P = .003), and increased residual postoperative curve (P = .003) [ 9 ]. Our study found an association between ASA scores of 3–4 and Cobb angles of 90 or more with infection. Furthermore, more infected patients had a more extended hospital stay (Tables 3 , 4 ). The literature suggests blood transfusions during spinal surgery may increase the risk of infection [ 21 ]. A 2018 systematic review found no consistent relation, indicating a need for a more optimal studies with higher power to examine the association[ 1 ]. In contrast, a 2019 meta-analysis [ 21 ] identified perioperative blood transfusion as a risk factor for postoperative infection, though it did not include pediatric patients. Despite our initial hypothesis, our study did not find any association between transfusions and infections in our sample. In our cohort, 34.6% of patients required intraoperative transfusions (Table 1 ), which aligns with existing literature. Sarwahi et al.[ 22 ] reported a transfusion incidence of 14–30% following surgical correction for adolescent idiopathic scoliosis (AIS) in their study of 485 patients. Different types of scoliosis exhibit varying transfusion rates. For example, in a study of 722 Asian patients, the rates were 14.8% for the syndromic type and 5.5% for the neuromuscular type[ 5 ]. Our cohort showed a notably higher transfusion rate of 64% for neuromuscular scoliosis (Table 2 ). This may be attributed to the higher complexity of cases typically managed in specialised referral centres in Latin America, where cerebral palsy is prevalent, and the proportion of more comorbid patients is likely greater. No systematic reviews or meta-analyses have been performed on risk factors for transfusion following scoliosis correction surgery in pediatric populations [ 4 ]. In that sense, our study adds value to this area of research, emphasising that several relations were encountered with risk factors that a priori can implicate a role in patients requiring perioperative blood transfusions (Tables 4 , 5 ). Additionally, the associations we encountered confirm that the most at-risk patients require further surgical team preparation due to their disease condition (type and presurgical Cobb angle) or quality of life (ASA score). Although the statistical analysis of this study presented in Table 5 is not a predictive model, as it does not meet all the criteria of the TRIPOD checklists, it provides an stratified view of the cumulative impact of multiple risk factors on transfusion or infection. This information may assist surgeons in preoperative evaluation and decision-making for complex scoliosis cases. Limitations : This study has several limitations. First , grouping patients with different scoliosis types (for example syndromic and idiopathic), to ensure subgroup size (transfusion and infection) could result in confounding, as patients with syndromic scoliosis are more likely to develop postoperative site infections and perioperative transfusion due to their comorbidities and not to the surgery itself. This limitation was mitigated by including the scoliosis type in the logistic regression. Second , specific surgical variables such as levels fused and instrumentation to the sacrum or ilium were not documented. These factors, particularly in incontinent neuromuscular patients, may influence infection risk due to proximity to contamination sources. Third , Surgeon identity and individual transfusion practices were also not reported. Although transfusion followed institutional guidelines, it depended on intraoperative factors like haemodynamic status, ASA score, and bleeding, limiting analysis of surgeon-specific variation. Fourth : While ASA classification and BMI were evaluated, BMI was excluded from the multivariate regression due to non-significant differences between groups, though it may still represent a clinical confounder. Fifth , Tranexamic acid was not considered a variable. Given tranexamic acid impact on perioperative blood loss, its omission could be a potential confounding factor that should be taken into account when interpreting the results. Sixth , surgical site infections (SSIs) were defined using CDC/NHSN criteria, but variability in institutional surveillance practices may affect comparability. Seventh , ethnic and racial backgrounds were not documented. This factor limits the generalisation of our Latin American cohort results with specific ethnic groups. Finally , access to health care in Colombia may have impacted our results. Although the Colombian health system offers universal coverage, there is inequality in access to specialised medicine[ 10 ]. Lengthy administrative processes and more comorbid patients (due to delayed treatment) in underserved regions may be independent risk factors for infection and transfusion that are very difficult to quantify. CONCLUSION Preoperative Cobb angle ≥ 90° and ASA 3–4 were independent risk factors of both transfusion and infection. Neuromuscular or Syndromic types of scoliosis and significant intraoperative bleeding were associated with transfusion risk. The higher the number of factors, the higher the cumulative risk of transfusion or infection. These findings offer valuable insights for preoperative risk stratification, enabling more effective planning in complex scoliosis cases with relevance for both Latin American and global pediatric populations. Declarations Author Contribution Juan José Martínez-Arboleda, María Fernanda García and Juan Pablo Díaz-Solórzano : Writing – review & editing, Writing – original draft, Supervision, Project administration, Methodology, Investigation, Conceptualization. María José Pérez-Bermúdez, María Carolina Suaza, Saidy I. Buendía-Pérez, Leslye Borrero-Carabali, Carlos Segundo Montero-Silva, Frank Mario Herrera, Fernando Alvarado-Gómez : Writing – review & editing, Writing – original draft, Supervision, Project administration, Investigation. Acknowledgement The authors thank Andres Mauricio Castro for his assistance with the statistical analysis. References Fisahn C, Schmidt C, Schroeder JE et al (2018) Blood transfusion and postoperative infection in spine surgery: a systematic review. 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Spine (Phila Pa 1976) 46(17):1326–1335. 10.1097/BRS.0000000000004011 Tables Table 1: Socio-demographic characteristics of Patients Included a Total n:427 Type of scoliosis, n (%) Idiopathic 243 (56.9%) Congenital 67 (15.7%) Neuromuscular 95 (22.2%) Syndromic 22 (5.2%) Gender, n (%) Male 140 (32.8%) Female 287 (67.2%) Age, mean ± SD 14.037 (± 2.355) BMI, median (IQR) 19.49 (17.22-19.81) ASA score , n (%) 1 – 2 377 (88.3%) 3 – 4 50 (11.7%) Pre-surgical Cobb angle, mean ± SD 54.654 (±18.744) Pre-surgical Hb, mean ± SD 14.738 (±1.220) Transfused, n (%) 148 (34.6%) Infected, n (%) 35 (8.2%) ASA, American Society of Anesthesiologists Classification; BMI, body mass index; Hb, Hemoglobin a Data are presented as n (%), median (interquartile groups) or mean (standard deviation). Table 2: Clinical characteristics of transfused patients a, b Total n :427 Not transfused n:279 Transfused n:148 P value b Type of scoliosis, n (%) Idiopathic 243 (56.9%) 181 (64.9%) 62 (41.9%) --- Congenital 67 (15.7%) 57 (20.4%) 10 (6.8%) <0.001 Neuromuscular 95 (22.2%) 34 (12.2%) 61 (41.2%) <0.001 Syndromic 22 (5.2%) 7 (2.5%) 15 (10.1%) <0.001 Gender, n (%) Male 140 (32.8%) 93 (33.3%) 47 (31.8%) 0.824 Female 287 (67.2%) 186 (66.7%) 101 (68.2%) Age, mean ± SD 14.037 (± 2.355) 13.907 (± 2.409) 14.284 (± 2.238) 0.115 BMI, median (IQR) 19.49 (17.22-19.81) 20.02 (17.68 - 22.30) 18.91 (16.84 - 21.34) <0.001 <18.5 167 (39.1%) 94 (33.7%) 73 (49.3%) 0.002 ≥ 18.5 260 (60.9%) 185 (66.3%) 75 (50.7%) ASA score , n (%) 1 – 2 377 (88.3%) 265 (95.0%) 112 (75.7%) <0.001 3 – 4 50 (11.7%) 14 (5.0%) 36 (24.3%) Pre-surgical Cobb angle, mean ± SD 54.654 (±18.744) 50.910 (±16.019) 62.024 (±21.420) <0.001 < 50°, n (%) 174 (40.75%) 134 (48.03%) 40 (27.03%) --- 50-70°, n (%) 176 (41.22%) 116 (41.58%) 60 (40.54%) 0.917 70-90°, n (%) 59 (13.82%) 25 (8.96%) 34 (22.97%) <0.001 ≥ 90°, n (%) 18 (4.22%) 4 (1.43%) 14 (9.46%) <0.001 Surgical time (minutes), median (IQR) 304.0 (252.5 - 368.5) 295 (240.0-346.0) 335.5 (290.8 - 405.5) 0.812 Bleeding in (ml), mean ± SD 983.286 (±571.746) 784.281 (±420.644) 1357.095 (±629.366) <0.001 Bleeding/blood volume 0-15%, n (%) 66 (15,46%) 61 (21,86%) 5 (3,38%) --- 15-30%, n (%) 148 (34,66%) 134 (48,03%) 14 (9,46%) <0.001 30-40%, n (%) 78 (18,27%) 50 (17,92%) 28 (18,92%) 0.902 ≥40%, n (%) 135 (31,62%) 34 (12,19%) 101 (68,24%) <0.001 ICU length of stay (days), mean ± SD 3.593 (±4.577) 2.697 (±2.395) 5.704 (±7.129) <0.001 Length of hospital stay (days), mean ± SD 6.980 (±4.344) 6.276 (±2.612) 8.596 (±6.566) <0.001 ASA, American Society of Anesthesiologists Classification; BMI, body mass index; Hb: Hemoglobin; ICU: Intensive care unit a Data are presented as n (%), median (interquartile groups [P < .05]) or mean ([standard deviation] [P < .05]). b Boldface P values indicate a statistically significant difference between groups: Chi-squared test, Fisher’s exact test, Student's t-test, Mann–Whitney U test (P < .05). Table 3: Clinical characteristics of infected patients a, b Total n :427 Not infected: 392 Infected n:35 P value b Type of scoliosis, n (%) Idiopathic 243 (56.9%) 230 (58.7%) 13 (37.1%) --- Congenital 67 (15.7%) 60 (15.3%) 7 (20.0%) 0.624 Neuromuscular 95 (22.2%) 82 (20.9%) 13 (37.1%) 0.045 Syndromic 22 (5.2%) 20 (5.1%) 2 (5.7%) 0.699 Gender, n (%) Male 140 (32.8%) 134 (34.2%) 6 (17.1%) 0.061 Female 287 (67.2%) 258 (65.8%) 29 (82.9%) Age, mean ± SD 14.037 (±2.355) 14.092 (±2.384) 13.429 (±1.929) 0.110 BMI, median (IQR) 19.5 (17.29-22.07) 19.79 (17.43 -22.09) 17.78 (15.64 - 21.37) 0.032 <18.5 167 (39.1%) 148 (37.8%) 19 (54.3%) 0.081 ≥ 18.5 260 (60.9%) 244 (62.2%) 16 (45.7%) ASA score , n (%) 1 – 2 377 (88.3%) 359 (91.6%) 18 (51.4%) <0.001 3 – 4 50 (11.7%) 33 (8.4%) 17 (48.6%) Pre-surgical Cobb angle, mean ± SD 55.537 (±18.246) 54.322 (±16.293) 69.143 (±30.181) <0.001 < 50° 174 (40.75%) 163 (41,58%) 11 (31.43%) --- 50-70° 176 (41.22%) 168 (42,86%) 8 (22,86%) 0.033 70-90° 59 (13.82%) 51 (13,01%) 8 (22,86%) 0.173 ≥ 90° 18 (4.22%) 10 (2,55%) 8 (22,86%) <0.001 Surgical time (minutes), median (IQR) 304.0 (252.5 - 368.5) 302.5 (252.8 - 363.5) 312.0 (250.0 - 401.0) 0.549 Bleeding in (ml), mean ± SD 983.286 (±571.746) 994.066 (±582.908) 862.857 (±415.215) 0.091 Bleeding (ml) /blood volume (ml) 0-15%, n (%) 66 (15,46%) 63 (16,07%) 3 (8,57%) --- 15-30%, n (%) 148 (34,66%) 137 (34,95%) 11 (31,43%) 0.815 30-40%, n (%) 78 (18,27%) 67 (17,09%) 11 (31,43%) 0.060 ≥40%, n (%) 135 (31,62%) 125 (31,89%) 10 (28,57%) 0.830 Blood transfusion, n (%) 148 (34.7%) 130 (33.2%) 18 (51.4%) 0.046 ICU length of stay (days), mean ± SD 3.593 (±4.577) 3.243 (±2.935) 8.042 (± 5.323) 0.079 Length of hospital stay (days), mean ± SD 6.980 (±4.344) 6.539 (±2.772) 12.833 (±11.661) 0.015 ASA, American Society of Anesthesiologists Classification; BMI, body mass index; Hb: Hemoglobin; ICU: Intensive care unit a Data are presented as n (%), median (interquartile groups [P < .05]) or mean ([standard deviation] [P < .05]). b Boldface P values indicate a statistically significant difference between groups: Chi-squared test, Fisher’s exact test, Student's t-test, Mann–Whitney U test (P < .05). Table 4: Multivariate Analysis of Risk Factors for Infection and transfusion after posterior instrumentation a Adjusted OR (CI 95%) P Value a Transfusion Type of scoliosis: Neuromuscular 3.551 (1.857 - 6.791) <0.001 Syndromic 3.492 (1.074 - 11.347) 0.038 Pre-surgical Cobb angle: 70-90 2.295 (1.071 - 4.915) 0.032 ASA score 3 – 4 2.928 (1.255 - 6.830) 0.013 Bleeding (ml) / blood volume (ml) ≥40% 13.452 (7.830 - 23.112) <0.001 Infection ASA score 3 – 4 8.108 (3.093 - 21.256) <0.001 Pre-surgical Cobb angle: Cobb ≥ 90° 5.919 (1.755 - 19.960) 0.004 ASA, American Society of Anesthesiologists Classification a Boldface P values indicate a statistically significant difference between groups (P < .05). Transfusion model: Hosmer and Lemeshow goodness of fit test: P:0.977, area under the curve: 0.852 Infection model: Hosmer and Lemeshow goodness of fit test: P:0.958, area under the curve: 0.752 Table 5: Accumulated risk of transfusion or infection by Number of Positive Factors a No. of Risk Factors b Outcome Not transfused n:279 Transfused n:148 Accumulated risk of transfusion 0 188 (67.38%) 20 (13.51%) 9.6% 1 71 (25.45%) 52 (35.14%) 42.3% 2 17 (6.09%) 38 (25.68%) 69.1% 3 3 (1.08%) 33 (22.29%) 91.7% 4 0 (0%) 5 (3.38%) 100% Not infected: 392 Infected n:35 Accumulated risk of Infection 0 352 (89.79%) 18 (51.43%) 4.9 % 1 37 (9.44%) 9 (25.71%) 19.6% 2 3 (0.77%) 8 (22.86%) 72.7% Data are presented as n (%) unless otherwise indicated. b The 4 risk factors for transfusion are: Type of scoliosis (Neuromuscular, Syndromic), Presurgical cobb: 70-90, ASA score 3-4 and bleeding (ml)/ blood volume (ml) > 40% c The 2 risk factors for infection are: Presurgical cobb > 90, ASA score 3-4 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Apr, 2026 Read the published version in European Spine Journal → Version 1 posted Editorial decision: Revision requested 29 Sep, 2025 Reviews received at journal 28 Sep, 2025 Reviews received at journal 22 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 14 Sep, 2025 Reviewers invited by journal 14 Sep, 2025 Editor assigned by journal 23 Aug, 2025 Submission checks completed at journal 23 Aug, 2025 First submitted to journal 20 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7421911","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":516971677,"identity":"20b1ea07-c010-48d8-9a96-5197d552d8f6","order_by":0,"name":"Juan José Martínez-Arboleda","email":"data:image/png;base64,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","orcid":"","institution":"Pontificia Universidad Javeriana","correspondingAuthor":true,"prefix":"","firstName":"Juan","middleName":"José","lastName":"Martínez-Arboleda","suffix":""},{"id":516971678,"identity":"641bc926-f1a3-4e75-8b6b-4bbfda4c4c26","order_by":1,"name":"Juan Pablo Díaz-Solórzano","email":"","orcid":"","institution":"Fundación Valle del Lili","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Pablo","lastName":"Díaz-Solórzano","suffix":""},{"id":516971680,"identity":"739df518-ef25-4479-bf50-c0465ec8eb5e","order_by":2,"name":"María José Pérez-Bermúdez","email":"","orcid":"","institution":"Universidad Icesi","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"José","lastName":"Pérez-Bermúdez","suffix":""},{"id":516971682,"identity":"e6b495b7-7b9b-4b41-a1e9-72a0b7a179df","order_by":3,"name":"María Fernanda García","email":"","orcid":"","institution":"Instituto Roosevelt","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Fernanda","lastName":"García","suffix":""},{"id":516971684,"identity":"bf232243-a467-408c-851e-8a3cb75859be","order_by":4,"name":"María Carolina Suaza","email":"","orcid":"","institution":"Pontificia Universidad Javeriana","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Carolina","lastName":"Suaza","suffix":""},{"id":516971685,"identity":"a27ee467-d59b-402a-94c2-b74a35a14448","order_by":5,"name":"Saidy I. Buendía-Pérez","email":"","orcid":"","institution":"Universidad de Cartagena","correspondingAuthor":false,"prefix":"","firstName":"Saidy","middleName":"I.","lastName":"Buendía-Pérez","suffix":""},{"id":516971686,"identity":"46a0b2d6-aa5c-474c-bec1-aa7a33fa7437","order_by":6,"name":"Leslye Borrero-Carabali","email":"","orcid":"","institution":"Instituto Roosevelt","correspondingAuthor":false,"prefix":"","firstName":"Leslye","middleName":"","lastName":"Borrero-Carabali","suffix":""},{"id":516971688,"identity":"b3cf88d9-014a-4653-a24a-cfd62dbcd508","order_by":7,"name":"Carlos Segundo Montero-Silva","email":"","orcid":"","institution":"Instituto Roosevelt","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Segundo","lastName":"Montero-Silva","suffix":""},{"id":516971690,"identity":"07c3075a-ba31-4913-8eef-0cbdbd15e516","order_by":8,"name":"Frank Mario Herrera","email":"","orcid":"","institution":"Instituto Roosevelt","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"Mario","lastName":"Herrera","suffix":""},{"id":516971691,"identity":"84cb4fa2-36e2-48f1-911c-775b39f0c902","order_by":9,"name":"Fernando Alvarado-Gómez","email":"","orcid":"","institution":"Instituto Roosevelt","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"","lastName":"Alvarado-Gómez","suffix":""}],"badges":[],"createdAt":"2025-08-21 03:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7421911/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7421911/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00586-026-09891-4","type":"published","date":"2026-04-01T15:58:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91958343,"identity":"ca65de37-4ea2-42ee-8460-c99c5450c402","added_by":"auto","created_at":"2025-09-23 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07:36:42","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110198,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7421911/v1/f8e52dbf6b829158b8d86762.html"},{"id":91958340,"identity":"b309b660-52b0-462c-9199-6ad0e8f0825d","added_by":"auto","created_at":"2025-09-23 07:36:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12594,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSTROBE (Strengthening the Reporting of Observational Studies in Epidemiology) flow diagram showing the sampling and inclusion of patients in the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7421911/v1/86ba820aaca5c54b866eb9d0.png"},{"id":106344739,"identity":"200772dc-cc3f-40ad-ae60-2648c31fa3e5","added_by":"auto","created_at":"2026-04-07 16:16:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1492197,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7421911/v1/207738ca-0625-4f81-beea-8da7ac4da8f1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk Factors for Transfusion and Infection Following Pediatric Scoliosis Surgery: Insights from a Latin American Retrospective Cohort","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBlood transfusions and infections are relatively common outcomes following spinal surgeries[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These outcomes can increase treatment costs and contribute to more challenging patient care, especially for patients with comorbidities[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIdentifying risk factors for these outcomes is required for effective preoperative planning in spinal surgery. Key risk factors for blood transfusions include a lower body mass index (BMI), lower preoperative haemoglobin levels, and greater fused spinal levels [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Comorbidities are often noted as significant risk factors for infections[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Notably, the risk factors for surgical site infections (SSI) and delayed infections overlap with those for blood transfusions. Despite existing evidence, research on these risk factors in pediatric spinal surgery is to some extent limited, particularly in non-Caucasic populations[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Local healthcare barriers in Colombia such as delayed access to specialised care and inequality in access [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] may influence outcomes. While major population differences cannot be assumed, the lack of local data warrants further investigation.Moreover, the cumulative effect of risk factors in scoliosis surgery in pediatric populations remains a relatively unexplored area[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study aims to identify risk factors for perioperative blood transfusion and postoperative infection following scoliosis correction surgery in a Latin American pediatric population. It will also quantify the cumulative risk for each outcome based on the number of coexisting factors, providing clinically useful data for preoperative risk stratification and planning in complex scoliosis cases.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and population:\u003c/h2\u003e\u003cp\u003eA retrospective analytical study was conducted at a single referral center in Latin America between January 1, 2014, and December 13, 2022. The study included 427 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e patients under 18 years old. Inclusion criteria were being younger than 18 and having undergone a scoliosis correction surgery (posterior instrumentation) at a single surgical time. There was no specific cutoff value requirement for the number of instrumented vertebral levels, and all cases, including those with pelvic fixation, were eligible. Patients with trauma, oncological pathology, multiple surgeries, or no information on transfusion or infection were excluded. The study adheres to the STROBE guidelines for reporting observational studies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe patients were divided into two groups based on intraoperative transfusion requirement or infection during the first year postoperatively. Baseline patient and operative characteristics were evaluated, including age, sex, preoperative and postoperative haemoglobin, body mass index, and ASA class. All data were entered and securely stored using a secure electronic data capture platform. All surgeries were performed by three senior spine surgeons with over 10 years of experience in treating deformities of the spine. The total number of patients undergoing scoliosis surgery during the study period, as well as the number and reasons for exclusions, are detailed in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSample size calculation\u003c/strong\u003e\u003cp\u003eThe sample size for both outcomes was calculated using a formula for estimating proportions in a population, ensuring 80% statistical power and a 5% alpha error for both procedures. For the infection outcome, an anticipated frequency of 2.82%, as reported in the scientific evidence[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], was used, which resulted in a sample size of 29 patients. For the transfusion outcome, an anticipated frequency of 32.8%, also based on the scientific evidence[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], led to a sample size of 229 patients.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003cp\u003e This study was approved by the institutional ethics committee. It adhered to ethical principles from the Declaration of Helsinki and local regulatory guidelines. Patient-informed consent was not required due to its retrospective nature.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOutcomes:\u003c/h3\u003e\n\u003cp\u003e\u003cb\u003eInfection\u003c/b\u003e: Surgical site infections (SSIs) were defined using the CDC/NHSN criteria[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], which classify infections into three categories: superficial incisional, deep incisional, or organ/space based on different parameters such as depth, purulent drainage, positive cultures, or intraoperative findings. We extended the monitoring period to 12 months postoperatively to document late infections, even though standard CDC guidelines recommend a 30-day supervision window ensuring a more comprehensive assessment of the outcome.The treating team verified all SSIs following institutional infection control procedures aligned with CDC/NHSN definitions. Antibiotic management was individualized for each patient based on intraoperative culture results.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBlood transfusion\u003c/strong\u003e\u003cp\u003e Clinical criteria based on established transfusion guidelines were used to define which patients required perioperative transfusion (up to 24 hours after surgery). In general, patients with haemoglobin levels below 8 g/dl were transfused, particularly those with comorbidities, high ASA scores, neuromuscular pathology, significant intraoperative bleeding and haemodynamic instability. Depending on the patient profile (risk factors and comorbidities), the cut-off point could vary. This approach is in line with the literature[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which generally supports restrictive transfusion protocols, where transfusion of blood products is allowed for patients with haemoglobin levels below 7g/dl with haemodynamic stability. Indications for transfusion were extracted from medical records and intraoperative anaesthesia reports. Tranexamic acid was routinely used as part of the institutional blood preservation protocol. No other blood saving techniques, such as intraoperative cell salvage (cell saver) among others, were utilized during surgery.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eData Analyses:\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate analysis\u003c/strong\u003e\u003cp\u003eData distribution was evaluated using the Shapiro‒Wilk test. Continuous variables were compared with the Mann‒Whitney U-tests if they were presented as medians or with Student's t-tests if they were presented as means. Categorical variables were compared using the chi-squared or Fisher's exact tests when the expected cell frequencies were less than 5. P values less than .05 were considered statistically significant.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMultivariate logistic regression\u003c/strong\u003e\u003cp\u003eAll types of scoliosis (congenital, idiopathic, neuromuscular, and syndromic) were analyzed together to ensure adequate sample size and statistical power. The type of scoliosis was incorporated as an independent variable in the multivariate logistic regression models, allowing both the assessment of its direct association with transfusion and infection risk and the control of its potential confounding effect.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe study explored the potential association between risk factors like Cobb angle, ASA score, type of scoliosis, and blood volume loss with postoperative infection or intraoperative blood transfusion. Odds ratio analyses were conducted with 95% confidence intervals. Multivariable logistic regressions were constructed using variables that could act as confounders for \u003cb\u003etransfusion requirement\u003c/b\u003e (Type of scoliosis, body mass index (BMI), ASA score, percentage of blood volume lost, and Cobb angle) and \u003cb\u003einfection\u003c/b\u003e (type of scoliosis, body mass index (BMI), ASA score, Cobb angle, percentage of blood volume lost and transfusion requirement.). Variables with P\u0026thinsp;\u0026lt;\u0026thinsp;.05 were allowed to remain in the regressions (Stepwise selection method).The evaluation of the logistic regressions was analysed using Hosmer‒Lemeshow Chi-squared tests, and the Bayesian Criterion Information data were used to choose the best logistic regression model per the parsimony principle. A receiver operating characteristics curve analysis was performed to evaluate the logistic regression's performance, and the area under the curve was calculated. All analyses were performed in RStudio software, version 2023.12.1\u0026thinsp;+\u0026thinsp;402.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAccumulated risk of transfusion or infecti\u0026oacute;n\u003c/strong\u003e\u003cp\u003eA new variable was created to define the number of risk factors and a exploratory stratified analysis was performed showing the observed frequency of transfusion and postoperative infection according to the cumulative presence of risk factors identified as significant in the multivariate model. This analysis is not a predictive model, as it does not meet all the criteria of the TRIPOD checklists [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003ePatient sociodemographic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost patients were female (67.2%), and the mean age was 14 years. Idiopathic scoliosis was the most prevalent type (56.9%). Most patients were ASA I-II (88.3%), with pre-surgical measures of a mean Cobb angle of 54.7 and a haemoglobin value of 14.7. Thirty-four point six per cent of the cohort was transfused, and 8.2% developed an infection. Further, sociodemographic characteristics are presented in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The characteristics of patients, stratified by infection and transfusion requirement, are presented in Tables \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate Analysis of Risk Factors for Infection and transfusion after Surgery\u003c/strong\u003e: Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e presents the multivariate analysis of risk factors for infection and transfusion as adjusted Odds Ratios (ORs) and Confidence Intervals (CIs). For transfusion risk, patients with neuromuscular and syndromic types of scoliosis had significantly higher odds of requiring transfusion, with adjusted ORs of 3.551 (95% CI: 1.857\u0026ndash;6.791, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and 3.492 (95% CI: 1.074\u0026ndash;11.347, \u003cem\u003eP\u003c/em\u003e .038), respectively. Pre-surgical Cobb angles between 70\u0026ndash;90\u0026deg; and ASA scores of 3\u0026ndash;4 were also associated with increased transfusion risk, with adjusted ORs of 2.295 (95% CI: 1.071\u0026ndash;4.915, \u003cem\u003eP\u003c/em\u003e .032) and 2.928 (95% CI: 1.255\u0026ndash;6.830, \u003cem\u003eP\u003c/em\u003e .0129). The highest transfusion risk ocurred in patients with a bleeding percentage per blood volume greater than 40% with an adjusted OR of 13.452 (95% CI: 7.830\u0026ndash;19.960, \u003cem\u003eP\u003c/em\u003e .004). Regarding infection risk, an ASA score of 3\u0026ndash;4 significantly increased infection odds, with an OR of 8.108 (95% CI: 3.093\u0026ndash;21.256, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), as did a pre-surgical Cobb angle\u0026thinsp;\u0026ge;\u0026thinsp;90\u0026deg;, with an OR of 5.919 (95% CI: 1.755\u0026ndash;19.960, \u003cem\u003eP\u003c/em\u003e .004). Logistic regression model for transfusion showed a non-significant Hosmer and Lemeshow goodness-of-fit test (P\u0026thinsp;=\u0026thinsp;0.977) and an area under the curve (AUC) of 0.852. The model for infection showed a Hosmer and Lemeshow P\u0026thinsp;=\u0026thinsp;0.958 and an AUC of 0.752.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAccumulated risk of transfusion or infection by Number of Positive Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe accumulated risk of transfusion increases from 9.6% when there are no risk factors to 100% when all four risk factors are present. Similarly, the accumulated risk of infection rises from 4.9% when there are no risk factors to 72.7% when both risk factors are present \u003cstrong\u003e(\u003c/strong\u003eTable \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn our study, 34.6% of patients required perioperative transfusions and 8.2% developed infections. Risk factors for transfusion included the type of scoliosis (syndromic or neuromuscular), presurgical Cobb angle of 70\u0026ndash;90\u0026deg;, ASA score of 3\u0026ndash;4, and a bleeding volume\u0026thinsp;\u0026gt;\u0026thinsp;40%. For infections, the highest risks were associated with an ASA score of 3\u0026ndash;4 and a Cobb angle of 90\u0026deg; or greater. Finally, the accumulated risk of transfusion increases from 9.6% with no risk factors to 100% when all four are present, while the accumulated risk of infection rises from 4.9% without factors to 72.7% with both present.\u003c/p\u003e\u003cp\u003eInfection rates following adolescent idiopathic scoliosis (AIS) correction surgery range between 0.71% and 4.7% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In contrast, Sharma et al. found an 11% infection rate in neuromuscular scoliosis patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although our overall (the sum of infection cases in all types of scoliosis ) infection rate is 8.2% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), our findings are similar to those reported in the literature when it comes to the percentage of infection according to scoliosis type, being 5.3% for AIS and 13.68% for neuromuscular scoliosis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere is a lack of high-quality studies on risk factors for postoperative infection in pediatric scoliosis correction surgery. A systematic review identified five risk factors in pediatric scoliosis surgery: inappropriate antibiotic use (P\u0026thinsp;=\u0026thinsp;.001), neuromuscular scoliosis (P\u0026thinsp;=\u0026thinsp;.014), levels of instrumentation (P\u0026thinsp;=\u0026thinsp;.023), increased hospital stay days (P\u0026thinsp;=\u0026thinsp;.003), and increased residual postoperative curve (P\u0026thinsp;=\u0026thinsp;.003) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our study found an association between ASA scores of 3\u0026ndash;4 and Cobb angles of 90 or more with infection. Furthermore, more infected patients had a more extended hospital stay (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe literature suggests blood transfusions during spinal surgery may increase the risk of infection [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A 2018 systematic review found no consistent relation, indicating a need for a more optimal studies with higher power to examine the association[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In contrast, a 2019 meta-analysis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] identified perioperative blood transfusion as a risk factor for postoperative infection, though it did not include pediatric patients. Despite our initial hypothesis, our study did not find any association between transfusions and infections in our sample.\u003c/p\u003e\u003cp\u003eIn our cohort, 34.6% of patients required intraoperative transfusions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which aligns with existing literature. Sarwahi et al.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reported a transfusion incidence of 14\u0026ndash;30% following surgical correction for adolescent idiopathic scoliosis (AIS) in their study of 485 patients. Different types of scoliosis exhibit varying transfusion rates. For example, in a study of 722 Asian patients, the rates were 14.8% for the syndromic type and 5.5% for the neuromuscular type[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Our cohort showed a notably higher transfusion rate of 64% for neuromuscular scoliosis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This may be attributed to the higher complexity of cases typically managed in specialised referral centres in Latin America, where cerebral palsy is prevalent, and the proportion of more comorbid patients is likely greater.\u003c/p\u003e\u003cp\u003eNo systematic reviews or meta-analyses have been performed on risk factors for transfusion following scoliosis correction surgery in pediatric populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In that sense, our study adds value to this area of research, emphasising that several relations were encountered with risk factors that \u003cem\u003ea priori\u003c/em\u003e can implicate a role in patients requiring perioperative blood transfusions (Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Additionally, the associations we encountered confirm that the most at-risk patients require further surgical team preparation due to their disease condition (type and presurgical Cobb angle) or quality of life (ASA score). Although the statistical analysis of this study presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e is not a predictive model, as it does not meet all the criteria of the TRIPOD checklists, it provides an stratified view of the cumulative impact of multiple risk factors on transfusion or infection. This information may assist surgeons in preoperative evaluation and decision-making for complex scoliosis cases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e: This study has several limitations. \u003cb\u003eFirst\u003c/b\u003e, grouping patients with different scoliosis types (for example syndromic and idiopathic), to ensure subgroup size (transfusion and infection) could result in confounding, as patients with syndromic scoliosis are more likely to develop postoperative site infections and perioperative transfusion due to their comorbidities and not to the surgery itself. This limitation was mitigated by including the scoliosis type in the logistic regression. \u003cb\u003eSecond\u003c/b\u003e, specific surgical variables such as levels fused and instrumentation to the sacrum or ilium were not documented. These factors, particularly in incontinent neuromuscular patients, may influence infection risk due to proximity to contamination sources. \u003cb\u003eThird\u003c/b\u003e, Surgeon identity and individual transfusion practices were also not reported. Although transfusion followed institutional guidelines, it depended on intraoperative factors like haemodynamic status, ASA score, and bleeding, limiting analysis of surgeon-specific variation. \u003cb\u003eFourth\u003c/b\u003e: While ASA classification and BMI were evaluated, BMI was excluded from the multivariate regression due to non-significant differences between groups, though it may still represent a clinical confounder. \u003cb\u003eFifth\u003c/b\u003e, Tranexamic acid was not considered a variable. Given tranexamic acid impact on perioperative blood loss, its omission could be a potential confounding factor that should be taken into account when interpreting the results. \u003cb\u003eSixth\u003c/b\u003e, surgical site infections (SSIs) were defined using CDC/NHSN criteria, but variability in institutional surveillance practices may affect comparability. \u003cb\u003eSeventh\u003c/b\u003e, ethnic and racial backgrounds were not documented. This factor limits the generalisation of our Latin American cohort results with specific ethnic groups. \u003cb\u003eFinally\u003c/b\u003e, access to health care in Colombia may have impacted our results. Although the Colombian health system offers universal coverage, there is inequality in access to specialised medicine[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Lengthy administrative processes and more comorbid patients (due to delayed treatment) in underserved regions may be independent risk factors for infection and transfusion that are very difficult to quantify.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePreoperative Cobb angle\u0026thinsp;\u0026ge;\u0026thinsp;90\u0026deg; and ASA 3\u0026ndash;4 were independent risk factors of both transfusion and infection. Neuromuscular or Syndromic types of scoliosis and significant intraoperative bleeding were associated with transfusion risk. The higher the number of factors, the higher the cumulative risk of transfusion or infection. These findings offer valuable insights for preoperative risk stratification, enabling more effective planning in complex scoliosis cases with relevance for both Latin American and global pediatric populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJuan Jos\u0026eacute; Mart\u0026iacute;nez-Arboleda, Mar\u0026iacute;a Fernanda Garc\u0026iacute;a and Juan Pablo D\u0026iacute;az-Sol\u0026oacute;rzano : Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Supervision, Project administration, Methodology, Investigation, Conceptualization. Mar\u0026iacute;a Jos\u0026eacute; P\u0026eacute;rez-Berm\u0026uacute;dez, Mar\u0026iacute;a Carolina Suaza, Saidy I. Buend\u0026iacute;a-P\u0026eacute;rez, Leslye Borrero-Carabali, Carlos Segundo Montero-Silva, Frank Mario Herrera, Fernando Alvarado-G\u0026oacute;mez : Writing \u0026ndash; review \u0026amp; editing, Writing \u0026ndash; original draft, Supervision, Project administration, Investigation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank Andres Mauricio Castro for his assistance with the statistical analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFisahn C, Schmidt C, Schroeder JE et al (2018) Blood transfusion and postoperative infection in spine surgery: a systematic review. 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J Bone Joint Surg Am 89(11):2427\u0026ndash;2432. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/JBJS.F.00995\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.F.00995\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharma S, Wu C, Andersen T et al (2013) Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 22(6):1230\u0026ndash;1249. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00586-012-2542-2\u003c/span\u003e\u003cspan address=\"10.1007/s00586-012-2542-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe YK, Li HZ, Lu HD (2019) Is blood transfusion associated with an increased risk of infection among spine surgery patients? a meta-analysis. Med (Baltim) 98(29):e16287. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000016287\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000016287\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarwahi V, Galina JM, Hasan S et al (2021) Minimally invasive versus standard surgery in idiopathic scoliosis patients: a comparative study. Spine (Phila Pa 1976) 46(17):1326\u0026ndash;1335. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/BRS.0000000000004011\u003c/span\u003e\u003cspan address=\"10.1097/BRS.0000000000004011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Socio-demographic characteristics of Patients Included \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"357\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n:427\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of scoliosis,\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003eIdiopathic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e243 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003eCongenital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e67 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003eNeuromuscular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e95 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003eSyndromic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e22 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e140 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e287 (67.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge,\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14.037 (\u0026plusmn; 2.355)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI,\u0026nbsp;\u003c/strong\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.49 (17.22-19.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e377 (88.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e3 \u0026ndash; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e50 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Cobb angle,\u003c/strong\u003e mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e54.654 (\u0026plusmn;18.744)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Hb,\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14.738 (\u0026plusmn;1.220)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfused,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e148 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 225px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfected, n\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e35 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 357px;\"\u003e\n \u003cp\u003eASA, American Society of Anesthesiologists Classification; BMI, body mass index; Hb, Hemoglobin\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ea Data are presented as n (%), median (interquartile groups) or mean (standard deviation).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Clinical characteristics of transfused patients \u003csup\u003ea, b\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n :427\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot transfused n:279\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfused n:148\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of scoliosis,\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003eIdiopathic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e243 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e181 (64.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e62 (41.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e---\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCongenital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e67 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e57 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e10 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003eNeuromuscular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e95 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e34 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e61 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003eSyndromic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e22 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e7 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e15 (10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e140 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e93 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e47 (31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e287 (67.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e186 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e101 (68.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge,\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e14.037 (\u0026plusmn; 2.355)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e13.907 (\u0026plusmn; 2.409)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e14.284 (\u0026plusmn; 2.238)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI,\u0026nbsp;\u003c/strong\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e19.49 (17.22-19.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e20.02 (17.68 - 22.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18.91 (16.84 - 21.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e167 (39.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e94 (33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e73 (49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026ge; 18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e260 (60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e185 (66.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e75 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e377 (88.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e265 (95.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e112 (75.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e3 \u0026ndash; 4 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e14 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e36 (24.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Cobb angle,\u003c/strong\u003e mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e54.654 (\u0026plusmn;18.744)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e50.910 (\u0026plusmn;16.019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e62.024 (\u0026plusmn;21.420)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026lt; 50\u0026deg;, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e174 (40.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e134 (48.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e40 (27.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e---\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e50-70\u0026deg;, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e176 (41.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e116 (41.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e60 (40.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e70-90\u0026deg;, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e59 (13.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e25 (8.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e34 (22.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026ge; 90\u0026deg;, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e18 (4.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e4 (1.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e14 (9.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical time (minutes),\u003c/strong\u003e median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e304.0 (252.5 - 368.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e295 (240.0-346.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e335.5 (290.8 - 405.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding in (ml),\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e983.286 (\u0026plusmn;571.746)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e784.281 (\u0026plusmn;420.644)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1357.095 (\u0026plusmn;629.366)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding/blood volume\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e0-15%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e66 (15,46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e61 (21,86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e5 (3,38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e---\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e15-30%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e148 (34,66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e134 (48,03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e14 (9,46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e30-40%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e78 (18,27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e50 (17,92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e28 (18,92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026ge;40%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e135 (31,62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 129px;\"\u003e\n \u003cp\u003e34 (12,19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e101 (68,24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU length of stay (days),\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.593 (\u0026plusmn;4.577)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2.697 (\u0026plusmn;2.395)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5.704 (\u0026plusmn;7.129)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay (days),\u003c/strong\u003e mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e6.980 (\u0026plusmn;4.344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e6.276 (\u0026plusmn;2.612)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.596 (\u0026plusmn;6.566)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 633px;\"\u003e\n \u003cp\u003eASA, American Society of Anesthesiologists Classification; BMI, body mass index; Hb: Hemoglobin; ICU: Intensive care unit\u003cbr\u003e\u0026nbsp;a Data are presented as n (%), median (interquartile groups [P \u0026lt; .05]) or mean ([standard deviation] [P \u0026lt; .05]). b Boldface P values indicate a statistically significant difference between groups: Chi-squared test, Fisher\u0026rsquo;s exact test, Student\u0026apos;s t-test, Mann\u0026ndash;Whitney U test (P \u0026lt; .05).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eClinical characteristics of infected patients \u003csup\u003ea, b\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n :427\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot infected: 392\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfected n:35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003csup\u003e\u0026nbsp;b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of scoliosis,\u003c/strong\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003eIdiopathic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e243 (56.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e230 (58.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e13 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e---\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003eCongenital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e67 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e60 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e7 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003eNeuromuscular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e95 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e82 (20.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e13 (37.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003eSyndromic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e20 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e2 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e140 (32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e134 (34.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e6 (17.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e287 (67.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e258 (65.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e29 (82.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge,\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14.037 (\u0026plusmn;2.355)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e14.092 (\u0026plusmn;2.384)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e13.429 (\u0026plusmn;1.929)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI,\u0026nbsp;\u003c/strong\u003emedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e19.5 (17.29-22.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e19.79 (17.43 -22.09)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e17.78 (15.64 - 21.37)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e167 (39.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e148 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e19 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026ge; 18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e260 (60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e244 (62.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e16 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e377 (88.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e359 (91.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e18 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e3 \u0026ndash; 4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e50 (11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e33 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e17 (48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Cobb angle,\u003c/strong\u003e mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e55.537 (\u0026plusmn;18.246)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e54.322 (\u0026plusmn;16.293)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e69.143 (\u0026plusmn;30.181)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026lt; 50\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e174 (40.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e163 (41,58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e11 (31.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e50-70\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e176 (41.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e168 (42,86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e8 (22,86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e70-90\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e59 (13.82%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e51 (13,01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e8 (22,86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026ge; 90\u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18 (4.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 (2,55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e8 (22,86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical time (minutes),\u003c/strong\u003e median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e304.0 (252.5 - 368.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e302.5 (252.8 - 363.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e312.0 (250.0 - 401.0)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding in (ml),\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e983.286 (\u0026plusmn;571.746)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e994.066 (\u0026plusmn;582.908)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e862.857 (\u0026plusmn;415.215)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding (ml) /blood volume (ml)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e0-15%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e66 (15,46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e63 (16,07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e3 (8,57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e15-30%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e148 (34,66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e137 (34,95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e11 (31,43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.815\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e30-40%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e78 (18,27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e67 (17,09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e11 (31,43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u0026ge;40%, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e135 (31,62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e125 (31,89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e10 (28,57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood transfusion, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e148 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e130 (33.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e18 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICU length of stay (days),\u0026nbsp;\u003c/strong\u003emean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3.593 (\u0026plusmn;4.577)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3.243 (\u0026plusmn;2.935)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e8.042 (\u0026plusmn; 5.323)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 221px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay (days),\u003c/strong\u003e mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e6.980 (\u0026plusmn;4.344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e6.539 (\u0026plusmn;2.772)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e12.833 (\u0026plusmn;11.661)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 652px;\"\u003e\n \u003cp\u003eASA, American Society of Anesthesiologists Classification; BMI, body mass index; Hb: Hemoglobin; ICU: Intensive care unit\u003cbr\u003e\u0026nbsp;a Data are presented as n (%), median (interquartile groups [P \u0026lt; .05]) or mean ([standard deviation] [P \u0026lt; .05]). b Boldface P values indicate a statistically significant difference between groups: Chi-squared test, Fisher\u0026rsquo;s exact test, Student\u0026apos;s t-test, Mann\u0026ndash;Whitney U test (P \u0026lt; .05).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Multivariate Analysis of Risk Factors for Infection and transfusion after posterior instrumentation \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfusion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of scoliosis:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003eNeuromuscular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e3.551 (1.857 - 6.791)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003eSyndromic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;3.492 (1.074 - 11.347)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Cobb angle: \u0026nbsp; \u0026nbsp; 70-90\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e2.295 (1.071 - 4.915)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score 3 \u0026ndash; 4\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e2.928 (1.255 - 6.830)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding (ml) / blood volume (ml) \u0026ge;40%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;13.452 (7.830 - 23.112)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA score 3 \u0026ndash; 4\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e8.108 (3.093 - 21.256)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 282px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgical Cobb angle: Cobb \u0026ge; 90\u0026deg;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e5.919 (1.755 - 19.960)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 538px;\"\u003e\n \u003cp\u003eASA, American Society of Anesthesiologists Classification\u003c/p\u003e\n \u003cp\u003ea Boldface P values indicate a statistically significant difference between groups (P \u0026lt; .05).\u003c/p\u003e\n \u003cp\u003eTransfusion model: Hosmer and Lemeshow goodness of fit test: P:0.977, area under the curve: 0.852\u003c/p\u003e\n \u003cp\u003eInfection model: Hosmer and Lemeshow goodness of fit test: P:0.958, area under the curve: 0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eAccumulated risk of transfusion or infection by Number of Positive Factors \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Risk Factors \u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot transfused n:279\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfused n:148\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccumulated risk\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e188 (67.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20 (13.51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e9.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e71 (25.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52 (35.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e42.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e17 (6.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e38 (25.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e69.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (1.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e33 (22.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e91.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e5 (3.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot infected: 392\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfected n:35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccumulated risk\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof Infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e352 (89.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18 (51.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e4.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e37 (9.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9 (25.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e19.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3 (0.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8 (22.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 227px;\"\u003e\n \u003cp\u003e72.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 586px;\"\u003e\n \u003cp\u003eData are presented as n (%) unless otherwise indicated.\u0026nbsp;\u003cbr\u003e\u0026nbsp;b The 4 risk factors for transfusion are: Type of scoliosis (Neuromuscular, Syndromic), Presurgical cobb: 70-90, ASA score 3-4 and bleeding (ml)/ blood volume (ml) \u0026gt; 40%\u003c/p\u003e\n \u003cp\u003ec The 2 risk factors for infection are: Presurgical cobb \u0026gt; 90, ASA score 3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Scoliosis, Fusion, Spinal, Complications, Blood transfusion, Infection, Pediatric","lastPublishedDoi":"10.21203/rs.3.rs-7421911/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7421911/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo identify risk factors for perioperative blood transfusion and postoperative infection following scoliosis correction surgery in a Latin American pediatric population and quantify the cumulative risk for each outcome based on the number of coexisting factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective analytical cohort study was conducted on patients under 18 years who underwent posterior scoliosis correction surgery at a single referral centre (2014\u0026ndash;2022). Exclusion criteria included spinal trauma, oncologic diagnoses, or multiple surgeries. Primary outcomes were perioperative blood transfusion and postoperative infection within one year. Odds ratios were calculated, and multivariate logistic regression identified independent risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong 427 patients, 34% required transfusion and 8.2% developed infection. Independent risk factors of transfusion included scoliosis type (neuromuscular or syndromic), Cobb angle (70\u0026deg;\u0026ndash;90\u0026deg;), ASA score (3\u0026ndash;4), and intraoperative blood loss\u0026thinsp;\u0026ge;\u0026thinsp;40% of blood volume. Infection was independently associated with ASA 3\u0026ndash;4 and Cobb angles\u0026thinsp;\u0026ge;\u0026thinsp;90\u0026deg;. Transfusion accumulated risk ranged from 9.6% (no factors) to 100% (four factors), while infection risk rose from 4.9\u0026ndash;72.7% (two factors).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePreoperative Cobb angle\u0026thinsp;\u0026ge;\u0026thinsp;90\u0026deg; and ASA 3\u0026ndash;4 were independent risk factors of both transfusion and infection. Neuromuscular or Syndromic types of scoliosis and significant intraoperative bleeding were associated with transfusion risk. The higher the number of factors, the higher the cumulative risk of transfusion or infection. These findings offer valuable insights for preoperative risk stratification, enabling more effective planning in complex scoliosis cases.\u003c/p\u003e","manuscriptTitle":"Risk Factors for Transfusion and Infection Following Pediatric Scoliosis Surgery: Insights from a Latin American Retrospective Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:36:37","doi":"10.21203/rs.3.rs-7421911/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-29T09:27:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T09:37:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-22T05:45:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"98307233858546311804730492469379016961","date":"2025-09-18T09:06:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167101150798025683552522112946673604336","date":"2025-09-14T16:54:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-14T16:51:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-23T12:15:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-23T12:14:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Spine Journal","date":"2025-08-21T03:39:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-spine-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"esjo","sideBox":"Learn more about [European Spine Journal](http://link.springer.com/journal/586)","snPcode":"586","submissionUrl":"https://submission.springernature.com/new-submission/586/3","title":"European Spine Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3c31f38e-6cae-43f1-8d2f-b790e7b98f51","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:13:56+00:00","versionOfRecord":{"articleIdentity":"rs-7421911","link":"https://doi.org/10.1007/s00586-026-09891-4","journal":{"identity":"european-spine-journal","isVorOnly":false,"title":"European Spine Journal"},"publishedOn":"2026-04-01 15:58:12","publishedOnDateReadable":"April 1st, 2026"},"versionCreatedAt":"2025-09-23 07:36:37","video":"","vorDoi":"10.1007/s00586-026-09891-4","vorDoiUrl":"https://doi.org/10.1007/s00586-026-09891-4","workflowStages":[]},"version":"v1","identity":"rs-7421911","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7421911","identity":"rs-7421911","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}