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Published on: November 3, 2016
Postoperative complications in pediatric patients with cerebral palsy
Nicholas J Skertich1, Martha-Conley E Ingram2, Gwyneth A Sullivan1
1Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, United States.
Insights
Patients with cerebral palsy (CP) experience more surgical complications and longer hospital stays compared to those without CP. Risk-directed planning may improve outcomes for these complex patients.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Cerebral Palsy Research
Background:
- Cerebral palsy (CP) affects motor function and can present complex challenges in pediatric surgical patients.
- Understanding surgical outcomes in CP patients is crucial for optimizing care and improving patient safety.
Purpose of the Study:
- To compare surgical outcomes between pediatric patients with and without cerebral palsy (CP).
- To identify factors contributing to differences in surgical outcomes for CP patients.
Main Methods:
- Utilized the NSQIP-Pediatric database (2012-2019) for patient data.
- Compared presenting characteristics and outcomes between CP and non-CP groups.
- Employed Chi-square tests and multivariable logistic regression for statistical analysis.
Main Results:
- Identified 119,712 patients (433 with CP, 119,279 without).
- CP patients had significantly higher rates of postoperative complications (19.4% vs. 6.9%), readmissions (10.2% vs. 3.8%), and reoperations (5.1% vs. 1.2%).
- CP patients underwent fewer laparoscopic procedures and had longer lengths of stay (LOS) (median 3 vs. 1 day). Multivariable analysis indicated patient complexity, not CP itself, increased morbidity risk.
Conclusions:
- Patients with cerebral palsy (CP) face increased postoperative complications, open procedures, and extended hospital stays.
- Higher patient complexity in CP cases likely accounts for observed outcome disparities.
- Risk-directed perioperative planning is recommended to enhance surgical outcomes for CP patients.
Background/Purpose:
To assess surgical outcomes of patients with cerebral palsy (CP) and if they differ from patients without CP.
Methods:
The NSQIP-Pediatric database from 2012 to 2019 was used to compare differences in presenting characteristics and outcomes between patients with and without CP. Chi-square tests and multivariable logistic regression analysis were used to determine significance.
Results:
119,712 patients, 433 (0.4%) with CP, 119,279 (99.6%) without, were identified. Patients with CP had more postoperative complications (19.4% vs. 6.9%, p < 0.001) with an OR of 3.2, (95%CI 2.5-4.1, p < 0.001) on univariable analysis. They underwent fewer laparoscopic procedures (79.1% vs. 90.8%, p < 0.001), had more readmissions (10.2% vs. 3.8%, p < 0.001), reoperations (5.1% vs. 1.2%, p < 0.001), and longer length of stays (LOS) (median 3 versus 1 day, p < 0.001). On multivariable analysis, having CP did not increase the odds of postoperative morbidity (OR 0.99, 95% CI 0.7-1.3), but higher ASA class, congenital lung malformation, gastrointestinal disease, coagulopathy, preoperative inotropic support, oxygen use, nutritional support, and steroid use significantly increase the odds of morbidity, all of which were more common in patients with CP.
Conclusion:
Patients with CP have more postoperative complications, open procedures, and longer LOS. Patient complexity may account for these differences and risk-directed perioperative planning may improve outcomes.
Level Of Evidence:
Level IV.
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