Hip Reconstruction in Nonambulatory Children With Cerebral Palsy: Identifying Risk Factors Associated With
Jodie Shea1, Kianna D Nunally1, Patricia E Miller1
1Department of Orthopaedic Surgery.
Insights
Preoperative comorbidities, not GMFCS level, significantly increase major complication risk in children with cerebral palsy undergoing hip reconstruction. Identifying high-risk patients preoperatively can improve care quality and reduce complications.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Cerebral palsy research
Background:
- Hip reconstruction is a complex procedure for nonambulatory children with cerebral palsy (CP).
- Preoperative comorbidities and surgical factors influence outcomes like complications and length of stay (LOS).
Purpose of the Study:
- To investigate the association between preoperative comorbidities, surgical complications, and LOS in nonambulatory children with CP undergoing hip reconstruction.
- To identify predictive factors for major complications and prolonged LOS.
Main Methods:
- Retrospective cohort study of 127 nonambulatory CP patients (GMFCS IV/V) undergoing hip surgery.
- Data collected on preoperative comorbidities, surgical details, complications, and LOS.
- Multivariable general linear modeling used to analyze associations.
Main Results:
- Each additional preoperative comorbidity increased the odds of a major complication by 2.6 times (OR, 2.64; P<0.001).
- Major complications, bilaterality, older age, female sex, and GMFCS V were associated with prolonged LOS.
- Comorbidities were more predictive of major complications than GMFCS level.
Conclusions:
- Preoperative comorbidities are stronger predictors of major complications than GMFCS level in this population.
- Preoperative risk stratification can aid in reducing complications and LOS.
- Improved identification of high-risk patients can enhance the quality of care for pediatric CP hip reconstruction.
Background:
The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP).
Methods:
This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS.
Results:
The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P=0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P<0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P<0.001), bilaterality (P=0.01), age (P=0.02), female sex (P=0.01), and GMFCS V (P<0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication.
Conclusions:
From our analysis, the authors found that a patient's premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery.
Level Of Evidence:
Level III-retrospective cohort study.
