{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:00:25Z","timestamp":1790589625639,"version":"4.1.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T00:00:00Z","timestamp":1772928000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Single-center retrospective review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the association between BMI Z-scores and postoperative complications in pediatric patients with neuromuscular scoliosis undergoing spinal instrumentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pediatric patients who underwent spinal instrumentation for neuromuscular scoliosis from July 2012 to June 2016 with a minimum 2-year follow-up were included. BMI and BMI Z-scores were calculated, and patients were stratified into CDC-defined BMI-for-age percentiles: underweight (&lt;5th percentile), normal (5th to &lt;85th percentile), overweight (85th to &lt;95th percentile), and obese (\u226595th percentile). Logistic regression assessed associations of BMI, BMI Z-score, and BMI groups with postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 147 patients were included. Average follow-up was 3.2 \u00b1 1.4 years. The most common diagnosis was cerebral palsy (39.5%). Complications occurred in 65 (44.2%) patients: 32 (21.8%) had a surgical site infection (SSI), 10 (6.8%) developed pneumonia, and 24 (16.3%) required return to the operating room within 90 days. Higher BMI Z-score was associated with increased odds of deep SSI (OR = 1.50,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.039), 30-day readmission (OR = 1.45,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.045), and reoperation within 90 days (OR = 1.52,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.026), and decreased odds of pneumonia (OR = 0.77,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.041). Similar associations were seen for BMI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher BMI Z-scores were associated with increased odds of deep SSI, readmission within 30 days, and return to the operating room within 90 days. Lower BMI Z-scores were associated with increased risk of developing pneumonia; however, this should be interpreted with caution as these patients had baseline pulmonary comorbidities. BMI Z-scores may be a useful adjunct for preoperative risk stratification in pediatric neuromuscular scoliosis patients undergoing spinal instrumentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Prognostic Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261430676","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:39:04Z","timestamp":1773225544000},"page":"3269-3276","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Association Between BMI Z-Score and Postoperative Complications in Pediatric Neuromuscular Scoliosis Surgery"],"prefix":"10.1177","volume":"16","author":[{"given":"Alexander K.","family":"Mihas","sequence":"first","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0983-0219","authenticated-orcid":false,"given":"Dion","family":"Birhiray","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"},{"name":"Georgetown University School of Medicine, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Wai","family":"Hung","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo R.","family":"Deveza","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dallas","family":"Vanorny","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Gerow","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrell","family":"Hanson","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benny","family":"Dahl","sequence":"additional","affiliation":[{"name":"Rigshospitalet and University of Copenhagen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,8]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPB.0000000000000996"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181f3a326"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bpb.0000271321.10869.98"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.2.PEDS17724"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001093"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000002464"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.21.00751"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000693"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003084"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.N.00277"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.03.005"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803300"},{"key":"e_1_3_8_14_2","unstructured":"Centers for Disease Control and Prevention NCfHS. 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