The Influence of Height‐Adjusted Nutritional Status Assessment on Complications Following Growing‐Rod Surgery for Early‐Onset Scoliosis

OBJECTIVES: Accurate nutritional assessment in children with early-onset scoliosis (EOS) is challenging because spinal deformity reduces measured standing height and may distort BMI-for-age classification. This study aimed to evaluate, using a longitudinal design, height-adjusted nutritional status before each growing-rod procedure throughout the treatment course and to investigate its association with postoperative complications in patients with EOS. METHODS: A retrospective cohort study included 53 patients with EOS who underwent 86 growing-rod procedures between January 2016 and January 2023, with each procedure serving as the unit of analysis. Nutritional status was reassessed before each analyzed procedure using BMI calculated from height corrected by the Ylikoski formula and was linked to the postoperative outcome of the corresponding procedure. Generalized estimating equations (GEE) were used to evaluate factors associated with postoperative complications while accounting for within-patient clustering. RESULTS: A total of 14 procedures resulted in postoperative complications, yielding an overall complication rate of 16.3% (14/86), with 15 specific complication events recorded. After height-adjusted BMI correction, 46 procedures were classified into the malnourished group and 40 into the normal nutrition group. The complication rate was significantly higher in the postadjusted malnourished group than in the normal nutrition group (23.9% vs. 7.5%, p = 0.042). Multivariable analysis using GEE revealed that undergoing ≥ 3 surgeries (OR = 4.614, 95% CI: 1.133-18.786, p = 0.033), and postadjusted malnutrition (OR = 3.701, 95% CI: 1.006-13.613, p = 0.049) were associated with increased risk of postoperative complications. However, after the Mancl-DeRouen small-sample correction, the association between height-adjusted malnutrition and complications was no longer statistically significant (OR = 4.21, 95% CI: 0.38-46.12, p = 0.239). CONCLUSIONS: Height-adjusted malnutrition and repeated surgeries (≥ 3) were associated with increased postoperative complications after growing-rod surgery in EOS patients. However, larger cohorts are needed to confirm these findings. The procedure-specific application of height-adjusted BMI provides an alternative approach to longitudinal nutritional assessment during repeated growing-rod treatment. Timely intervention should be implemented for patients with poorer nutritional status.