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Hospitalizations Following Complex Hip Surgery in Children with Intellectual Disability: A Self-Controlled Case
Keerthi Anpalagan1, Peter Jacoby1, Katherine Stannage2
1Centre for Child Health Research, The Kids Research Institute Australia, The University of Western Australia, Perth, Australia.
Insights
Complex hip surgery in children with intellectual disability reduced overall hospitalizations but did not decrease respiratory infections. This suggests potential benefits for musculoskeletal alignment despite increased respiratory risks.
Area of Science:
- Pediatric Orthopedics
- Disability Studies
- Health Services Research
Background:
- Children with intellectual disability often have complex orthopedic conditions requiring surgical intervention.
- Cerebral palsy is a common comorbidity in this population, further complicating surgical outcomes.
- Understanding the impact of complex hip surgery on subsequent hospitalizations is crucial for optimizing care.
Purpose of the Study:
- To investigate the association between complex hip surgery and subsequent hospitalizations in children with intellectual disability.
- To specifically examine hospitalizations related to all-causes, lower respiratory tract infections, and epilepsy.
- To analyze these associations in a subset of children with cerebral palsy.
Main Methods:
- Retrospective cohort study utilizing linked administrative, health, and disability data.
- Inclusion of children born between 1983-2009 who underwent complex hip surgery by end 2014.
- Self-controlled case series analysis with Poisson regression to compare post-operative periods with the pre-operative year.
Main Results:
- Overall hospitalizations decreased significantly in the years following complex hip surgery (IRR 0.57 at year 6).
- Hospitalizations for lower respiratory tract infections showed an increasing trend post-surgery (IRR 2.08 at year 6).
- Hospitalizations for epilepsy decreased post-surgery, though not statistically significant in all periods.
Conclusions:
- Complex hip surgery is linked to reduced overall hospitalizations in children with intellectual disability.
- The surgery did not reduce, and may increase, respiratory-related hospitalizations.
- Findings suggest potential benefits for musculoskeletal alignment but highlight the need for vigilance regarding respiratory health.
Objective:
To evaluate the associations between complex hip surgery and subsequent hospitalizations in children with intellectual disability, including a subset of children with cerebral palsy.
Study Design:
We conducted a retrospective cohort study using linked administrative, health, and disability data from Western Australia. Children born between 1983 and 2009 who underwent complex hip surgery by end 2014 were included (intellectual disability, n = 154; subset with cerebral palsy, n = 91). A self-controlled case series analysis using Poisson regression was used to estimate the age-adjusted associations of complex hip surgery on all-cause hospitalizations and when the principal diagnosis was lower respiratory tract infection or epilepsy, for periods following the individual's first major hip surgery, compared with the year before surgery.
Results:
Age adjusted incidence of all-cause hospitalizations decreased after surgery (year 1: incidence rate ratio [IRR] 0.87 [95% CI, 0.74-1.02]; year 6: IRR 0.57 [95% CI, 0.46-0.72]). The incidence of hospitalizations for lower respiratory tract infection increased (year 1: IRR, 1.03 [95% CI, 0.72-1.51]; year 6: IRR 2.08 [95% CI, 1.18-3.68]). The incidence of hospitalizations for epilepsy decreased (year 1: IRR 0.93 [95% CI, 0.57, 1.54]; year>6: IRR 0.72 [95% CI, 0.34-1.55]) after surgery. A similar pattern was observed for the subset of children with or without cerebral palsy.
Conclusion:
Complex hip surgeries are associated with fewer hospitalizations overall but not respiratory hospitalizations for children with intellectual disability. Fewer hospitalizations suggest benefits for better musculoskeletal alignment.
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