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Postoperative Complications After Hip Surgery in Patients With Cerebral Palsy: A Retrospective Matched Cohort Study
Rachel DiFazio1, Judith A Vessey, Patricia Miller
1*Orthopedic Center, Boston Children's Hospital ‡Boston Children's Hospital, Boston †William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.
Insights
Patients with severe cerebral palsy (CP) undergoing hip surgery face nearly double the risk of postoperative complications, primarily medical, compared to non-CP patients. Costs for managing these complications are higher overall for CP patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Limited data exists on postoperative complications in severe cerebral palsy (CP) patients (GMFCS IV-V) undergoing hip surgery.
- This study compares complication rates, types, and severity between severe CP and non-CP hip dysplasia patients.
Purpose of the Study:
- To determine differences in postoperative complication incidence, type, and severity between severe CP and non-CP patients undergoing hip osteotomies.
- To identify risk factors for complications in these patient groups.
- To evaluate the number and cost of additional healthcare utilization due to complications.
Main Methods:
- Retrospective matched cohort study of 55 severe CP patients and 55 non-CP patients (ages 3-25) who underwent hip osteotomies.
- Complications assessed using the adapted Clavien-Dindo classification.
- Logistic regression analyzed risk factors; costs and utilization were calculated.
Main Results:
- Severe CP patients experienced nearly twice as many complications (1.82 RR, P=0.004) compared to non-CP patients.
- Medical complications predominated in CP patients (83%), while orthopedic complications were more frequent in non-CP patients (59%).
- Complication severity was similar, but unplanned visits were significantly higher in CP patients (P≤0.001).
Conclusions:
- Patients with severe CP have a 65% chance of at least one postoperative complication versus 36% for non-CP patients.
- While per-patient costs are similar, overall complication-related costs are higher for CP patients due to increased medical issues and utilization.
- This highlights the need for tailored perioperative care strategies for severe CP patients undergoing hip surgery.
Background:
Little is known about the postoperative complications experienced by patients with severe cerebral palsy (CP) (GMFCS IV-V) compared with otherwise healthy patients with hip pathology requiring surgery. The purpose of this study was to determine whether differences exist between these 2 groups with respect to the incidence, type, and severity of complications. In addition, we evaluated the risk factors for complications and the number and cost of additional visits, hospital admissions, and repeat surgeries due to complications.
Methods:
Retrospective matched cohort study of 55 patients aged 3 to 25 years with severe CP and 55 non-CP patients with hip dysplasia who underwent hip osteotomies (2000 to 2012). Postoperative complications were evaluated using the adapted Clavien-Dindo classification system. Binary and ordinal logistic regressions were used to identify risk factors for complications. The number and cost of unplanned visits, admissions, and surgeries were calculated.
Results:
CP patients experienced almost twice as many complications as the non-CP patients (P=0.004). All types of complications occurred in both groups except orthopaedic complications (P<0.001) were more frequent in the non-CP group. CP patients were 82% more likely to develop a complication compared with non-CP patients (relative risk=1.82; 95% confidence interval=1.21 to 2.76). The severity of complications was comparable with no significant differences in the relative distribution between the groups. There was a significant difference between groups for the number of unplanned clinic and emergency department visits (P≤0.001). The average cost for treating a complication was $1857.00 for CP and $1800.00 for non-CP (P=0.72).
Conclusions:
Although patients with severe CP requiring hip surgery have a 65% chance of experiencing at least 1 postoperative complication compared with 36% of non-CP patients, most of the complications were medical in the CP patients (n=46, 83%) as opposed to the non-CP patient who experienced predominantly orthopaedic complications (59%). When these complications occur the associated costs are greater for CP patients as a whole, but are relatively similar per patient.
Level Of Evidence:
Level III—Prognostic, case-control study.
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