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Effects of preoperative gait analysis on costs and amount of surgery
Tishya A L Wren1, Michael M Kalisvaart, Christine E Ghatan
1Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. twren@chla.usc.edu
Insights
Clinical gait analysis (GA) in children with cerebral palsy (CP) reduces the need for subsequent surgeries, despite higher initial costs. This approach lessens patient life disruption and aids healthcare decision-making.
Area of Science:
- Orthopedics
- Pediatrics
- Rehabilitation Medicine
Background:
- Ambulatory children with cerebral palsy (CP) often undergo multiple lower extremity surgeries.
- The impact of clinical gait analysis (GA) on surgical interventions and care costs in this population is not fully understood.
Purpose of the Study:
- To evaluate the effect of clinical gait analysis (GA) on the number of surgeries and associated care costs in ambulatory children with CP.
Main Methods:
- Retrospective review of 462 ambulatory CP patients undergoing lower extremity surgery (1991-2005).
- Patients were divided into groups with (GA group, N=313) and without (NGA group, N=149) pre-operative GA.
- Comparison of surgical procedures, follow-up surgeries, and direct costs, including surgeon, anesthesia, OR, hospital stay, physical therapy, and GA fees.
Main Results:
- The GA group had more procedures and higher initial costs during index surgery ($43,006 vs. $35,215).
- However, the GA group underwent significantly fewer subsequent surgeries (11% vs. 32%) and lower additional costs ($916/person-year vs. $3009/person-year).
- Total procedures and costs over the study period did not differ significantly between groups.
Conclusions:
- Clinical gait analysis (GA) is linked to a reduced incidence of additional surgeries in ambulatory children with CP.
- This reduction in further surgical procedures leads to less disruption in patients' lives.
- Findings support GA as a valuable tool for optimizing surgical planning and care management in pediatric CP.
Background:
The purpose of this study was to determine the effects of clinical gait analysis (GA) on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery these children undergo.
Methods:
A retrospective review identified all ambulatory patients with CP who had undergone lower extremity orthopaedic surgery at our hospital from 1991 to 2005 with at least a 6-month follow-up. The patients were grouped into those who had undergone GA before their index surgery (GA group, N=313) and those who had not (NGA group, N=149). The groups were compared in terms of the number of procedures during index surgery and subsequent surgeries and the direct costs associated with these surgeries. Costs were calculated in US dollars by using a standardized protocol including fees for the surgeon, anesthesia, operating room, hospital stay, physical therapy, and GA.
Results:
Patients in the GA group were significantly older and less functionally involved, had their first surgery in later years, and had a shorter follow-up than patients in the NGA group (P<0.001). Adjusting for these differences, patients in the GA group had more procedures (GA: 5.8, NGA: 4.2; P<0.001) and higher cost (GA: $43,006, NGA: $35,215; P<0.001) during index surgery, but less subsequent surgery. A higher proportion of patients went on to additional surgery in the NGA group (NGA: 32%, GA: 11%; P<0.001), with more additional surgeries per person-year (NGA: 0.3/person-year, GA: 0.1/person-year; P<0.001) resulting in higher additional costs (NGA: $3009/person-year, GA: $916/person-year; P<0.001). The total number of procedures (GA: 2.6/person-year, NGA: 2.3/person-year; P=0.22) and cost (GA: $20,448/person-year, NGA: $19,535/person-year; P=0.58) did not differ significantly between the 2 groups.
Conclusions:
Clinical GA is associated with a lower incidence of additional surgery, resulting in lesser disruption to patients' lives. This finding has not been shown before and may assist patients, physicians, policy makers, and insurance companies in assessing the role of GA in the care of ambulatory children with CP.
Level Of Evidence:
Level III, retrospective comparative study.
