Ten-year trends of intraoperative adverse events during scoliosis surgery: insights from the British Spine Registry

AIM: To quantify the intraoperative adverse events (AEs) during surgical correction of Adolescent Idiopathic Scoliosis (AIS) and adolescent non-idiopathic scoliosis and identify predictors for such events using the British Spine Registry (BSR) dataset. METHODS: Clinician-reported intraoperative AEs during AIS and non-idiopathic scoliosis procedures were collected from the BSR database. Data included deformity pathways for 10-18-year-olds diagnosed between 2012 and 2023. Intraoperative AEs included excessive bleeding, dural tears, implant malposition, neuromonitoring (IONM) changes, spinal cord injury, and cardiac complications. Hospital Episode Statistics (HES) were monitored to determine the reporting rate. Univariable analysis was utilised to calculate unadjusted Odds ratios (ORs) and 95% confidence intervals (CIs) for key risk factors. RESULTS: 9,889 scoliosis procedures were analysed (7690 AIS & 2199 non-idiopathic). Intraoperative AEs occurred in 3.0% of AIS and 6.7% of non-idiopathic cases. In AIS, combined anterior and posterior approaches had significantly higher odds of AEs compared to posterior-only (OR 2.08, 95% CI 1.14-3.79), and revision procedures carried greater risk than primary (OR 1.76, 95% CI 1.14-2.71). In the non-idiopathic group, the combined approach was also associated with significantly higher AE risk (OR 2.37, 95% CI 1.15-4.91), and revision surgery had higher odds of AEs than primary procedures (OR 1.54, 95% CI 1.00-2.37). Comparison with HES data revealed 56% reporting compliance to BSR. In AIS patients, AEs were not associated with clinically significant differences in postoperative SRS-22 outcomes. CONCLUSIONS: Non-idiopathic scoliosis surgery was associated with higher BSR-reported intraoperative AE rates compared to AIS. The findings in this study are important for preoperative counselling and underscore the need to improve registry completeness.