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Correlation Between GDI Improvements in Cerebral Palsy Patients After Orthopaedic Surgical Interventions and COI
Akshitha Adhiyaman1, Amith Umesh, Olivia C Tracey
1Hospital for Special Surgery, New York, NY.
Insights
Socioeconomic status does not impact gait improvement in pediatric cerebral palsy patients after surgery. Equitable surgical outcomes are achievable across diverse socioeconomic backgrounds with current care models.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Gait analysis
Background:
- Lower socioeconomic status (SES) is linked to poorer perioperative outcomes in orthopaedic surgery.
- Pediatric patients with cerebral palsy (CP) from low SES backgrounds may be especially vulnerable to adverse outcomes.
- The Child Opportunity Index (COI) is a measure of socioeconomic status.
Purpose of the Study:
- To investigate the relationship between socioeconomic status, measured by the Child Opportunity Index (COI), and gait improvement in pediatric patients with cerebral palsy (CP) undergoing orthopaedic surgery.
- To determine if COI influences the Gait Deviation Index (GDI) improvement post-intervention.
Main Methods:
- Retrospective review of pediatric CP patients (GMFCS 1-2) with pre- and post-operative gait analysis.
- COI determined by patient zip codes; GDI improvement calculated from gait analysis scores.
- Multivariable regression, Mann-Whitney U, and ANOVA used to analyze the association between COI and GDI improvement.
Main Results:
- No significant association was found between overall COI and GDI improvement (P=0.099).
- GDI improvement did not differ significantly between low and high COI groups (P=0.051) or across COI quartiles (P=0.462).
- The study included 49 pediatric CP patients with a mean GDI improvement of 9.3±9.8.
Conclusions:
- Orthopaedic surgical interventions provide comparable gait improvements for pediatric CP patients, irrespective of their socioeconomic status.
- Equitable outcomes may be attributed to multidisciplinary teams providing specialized, longitudinal care.
- Current care models can achieve equitable surgical outcomes for ambulatory children with CP across the socioeconomic spectrum.
Introduction:
Orthopaedic literature suggests that patients with lower socioeconomic status (SES) have worse perioperative outcomes and higher complication rates after surgical interventions compared with patients with higher SES. Pediatric patients with cerebral palsy (CP) from low SES may be particularly vulnerable. This study aims to determine the relationship between SES as measured by the Child Opportunity Index (COI) and improvements in Gait Deviation Index (GDI) following orthopaedic surgical interventions in pediatric patients with CP.
Methods:
Pediatric patients with CP (age 18 and below) with Gross Motor Function Classification System (GMFCS) 1 or 2 who underwent preoperative and postoperative gait analysis at an urban, tertiary medical center were retrospectively identified. COI was determined by patient zip codes. Improvement in GDI was determined using preoperative and postoperative GDI scores. Multivariable regression was used to determine the association between GDI improvement and COI. Mann-Whitney U was used to compare GDI improvement between patients in low and high COI categories. ANOVA was used to compare the GDI improvement between the 4 quartiles of COI. After Bonferroni correction, the significance threshold was set at P <0.004.
Results:
This study included 49 patients (mean age at surgery 11.3±3.4, 36.7% female, 69.4% non-Hispanic). The mean GDI improvement was 9.3±9.8 (-12.8 to 63.2) and the mean COI score was 50.3±34.5 (2 to 100). There were no significant associations between GDI improvement and overall COI (P=0.099). GDI change was not different between low and high COI groups (P=0.051) or COI quartiles (P=0.462).
Conclusion:
Surgical interventions for pediatric patients with CP provided similar improvements in gait regardless of patient socioeconomic status. Equitable surgical outcomes in this study may result from the multi-disciplinary teams who delivered longitudinal and specialized care for the study participants. It is possible that lower COI patients require more resources than higher COI patients to achieve these outcomes, which could be an area for future study. This study provides reassurance that equitable surgical outcomes for ambulatory children with CP can be achieved across the socioeconomic spectrum with currently available care models.
Level Of Evidence:
Level III.
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