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Perioperative Complications of Pediatric Orthopaedic Surgery in Sickle Cell Disease
Daniel Lorenzana1, Crystal A Perkins, S Clifton Willimon
1Children's Healthcare of Atlanta Atlanta, GA.
Insights
Pediatric patients with sickle cell disease (SCD) face a 16% risk of complications after orthopedic surgery. Hip surgeries and prior emergency department visits increase this risk significantly.
Area of Science:
- Orthopedic Surgery
- Pediatric Hematology
- Sickle Cell Disease Management
Background:
- Sickle cell disease (SCD) patients experience vasoocclusion triggered by factors like cold, hypoxia, infection, dehydration, and stress, all potential surgical complications.
- Perioperative complications in pediatric SCD patients undergoing orthopedic surgery require identification of predictive factors.
Purpose of the Study:
- To identify predictors of perioperative complications in pediatric patients with sickle cell disease undergoing orthopedic surgery.
Main Methods:
- A single-center retrospective review of pediatric patients (≤21 years) with SCD undergoing orthopedic surgery between 2009-2019.
- Data included patient history, preoperative interventions (hydration, blood transfusion), laboratory results, and surgical details.
- Primary outcome: postoperative complications within 30 days, defined by ED visit or hospital admission.
Main Results:
- 118 surgeries in 92 pediatric SCD patients were analyzed; 16% experienced postoperative complications.
- Hip surgeries (24%) had significantly more complications than other sites (9%).
- Four or more prior ED visits (OR 5.7) and preoperative blood transfusions (27% vs. 5%) were associated with increased complication rates.
Conclusions:
- Pediatric SCD patients have a 16% risk of postoperative complications after orthopedic surgery.
- Hip surgery and a history of frequent ED visits are significant risk factors for complications.
- Preoperative blood transfusion was unexpectedly linked to higher complication rates, warranting further investigation.
Background:
Vasoocclusion in sickle cell disease can be precipitated by cold temperatures, hypoxia, infection, dehydration, and stress, all of which can occur in the setting of surgery. The purpose of this study was to identify predictors of perioperative complications among pediatric patients with sickle cell disease undergoing orthopaedic surgery.
Methods:
An institutional review board approved single-center retrospective review was conducted of pediatric patients 21 years of age and younger with SCD who underwent any orthopaedic surgery at a single center between 2009 and 2019. Patient data and procedure-specific information were recorded. Preoperative admission for hydration and/or blood transfusion and preoperative laboratory studies were reviewed. The primary study outcome was postoperative complications within 30 days of surgery requiring an ED visit or hospital admission.
Results:
Ninety-two patients who underwent 118 orthopaedic surgeries were identified. The average age at surgery was 12.0 years (SD 4.8 y). Surgical cases were classified as elective (n=82, 70%), infection (n=26, 22%), and trauma (n=9, 8%). The lower extremity was the most frequent surgical site (n=86, 73%). Sixty surgeries (51%) received a preoperative blood transfusion. There were 19 surgeries with postoperative complications (16%) that required an ED visit or hospital readmission within 30 days of surgery. There were significantly more complications following surgery on the hip as compared with other sites (24% vs. 9%, P =0.04). Four or more ED visits in the past year were associated with an OR of 5.7 for a postoperative complication ( P =0.01, 95% CI 1.6-20.5). Patients who had a preoperative blood transfusion had significantly greater rates of complications than those that did not (27% vs. 5%, P <0.01).
Conclusions:
Children with SCD are at increased risk for complications after orthopaedic surgery, and the current study found an overall postoperative complication rate of 16%. Patients undergoing hip surgery had a disproportionate number of complications, with a 5.8-fold increased risk of a postoperative complication. Patients with 4 or more ED visits in the past year had a 5.7-fold increased risk of a complication.
Level Of Evidence:
IV Retrospective case series.
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