Hemiepiphysiodesis: when should it be considered a day-case procedure?

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Pain Management

Background:

• Hemiepiphysiodesis is a surgical procedure to correct coronal plane deformities in children.
• It is typically an outpatient procedure, but some patients require overnight stays for pain management.
• Assessing factors influencing pain and length of stay is crucial for optimizing patient care.

Purpose of the Study:

• To evaluate the factors affecting the level of analgesia (LOA) and length of stay (LOS) in patients undergoing hemiepiphysiodesis around the knee.
• To identify key parameters that influence postoperative pain and hospital duration.

Main Methods:

• Retrospective cohort study of 79 patients undergoing temporary hemiepiphysiodesis using eight-plates for coronal deformities (distal femur or proximal tibia).
• Data collected included demographics, procedure type, anatomical site, anesthesia details, analgesia use (pre-, intra-, and post-operative), and surgery timing.
• Exclusion criteria: anterior hemiepiphysiodesis and permanent drill epiphysiodesis.

Main Results:

• Increased American Society of Anesthesiologists (ASA) score (>1) and operating on more than two sites correlated with higher LOA and prolonged LOS (P < 0.05).
• Surgery timing (morning vs. afternoon) did not impact LOS or LOA.
• Patient-controlled analgesia (PCA) was required in 57% of patients with four growth plates operated on, and all PCA patients stayed overnight.
• Intraoperative local infiltration significantly reduced postoperative LOA and facilitated earlier discharge (P < 0.05).

Conclusions:

• Number of growth plates operated on, tourniquet use, and intraoperative local infiltration are independent predictors of postoperative LOS and LOA.
• These findings are essential for patient and family consultations and planning postoperative care for hemiepiphysiodesis procedures.