Multidisciplinary Risk Assessment Outcomes Are Associated With 30‐Day in Hospital Complications Following Pediatric Scoliosis Surgery: Evaluation of a Three‐Tiered Traffic‐Light Triage System at Great Ormond Street Children's Hospital

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BACKGROUND: Scoliosis surgery is complex and associated with significant morbidity. Accurate risk assessment is essential for appropriate resource allocation and improved care. Risk factors for developing complications have been identified; however, structured frameworks to support preoperative assessment are limited. Great Ormond Street Hospital (GOSH) uses a three-tier multidisciplinary team (MDT) traffic-light system to triage patients based on well-defined risk factors and expert clinical judgment. AIM: We aimed to describe complications following scoliosis surgery at GOSH and evaluate the relationship between preoperative MDT traffic-light assessment and outcomes such as complication rates, operative times, and length of stay. METHOD: A retrospective hospital file review was conducted for all patients presenting to GOSH for primary scoliosis surgery between January 2019 and December 2023. Institutional approval was obtained, and the need for ethical approval was waived. Preoperative risk is quantified by the MDT using a three-tier traffic-light system categorizing patients as low (green), intermediate (amber), and high-risk (red). Outcomes including 30-day in-hospital complications, operative time, and length of stay were analyzed in relation to preoperative MDT traffic-light score. RESULTS: Of 350 eligible patients, 337 had a documented preoperative MDT traffic-light assessment. Low-risk patients comprised 43.6% (n = 147/337), intermediate-risk 49.3% (n = 166/337), and high-risk 7.1% (n = 24/337). Major complications occurred in 2% (n = 3/147) of low-risk patients compared with 50% (n = 12/24) of high-risk patients, corresponding to an adjusted odds ratio of 11.4 ([95% CI 1.98-65.4], p = 0.006). High-risk patients also had significantly longer operative times (381 min vs. 320 min, p < 0.001) and length of stay (12 days vs. 5 days, p < 0.001) when compared to low-risk patients. CONCLUSION: Patients classified as high-risk by the MDT demonstrated an increased odds of developing major complications, longer operative time, and extended length of stay when compared to low-risk patients. Similar structured tools, with local adaptations, may be valuable in other centers to support preoperative assessment, shared decision making, and guide resource allocation.