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Trends in Reconstructive Hip Surgery for Cerebral Palsy in U.S. Community Hospitals Before and After Publication of
Shana Kong1, Jingyanshan Li1, Shannon Tse2
1University of California Davis, School of Medicine, Sacramento, CA, USA.
Insights
Hip surgery rates decreased in children with cerebral palsy (CP) after national guidelines were introduced. This suggests guidelines may influence surgical management, but further implementation is needed for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Medicine
- Public Health
Background:
- National hip surveillance guidelines for children with cerebral palsy (CP) were established by the Australian (AusACPDM, 2008) and American (AACPDM, 2016) Academies.
- The impact of these guidelines on surgical management trends for hip displacement in children with CP remains unclear.
Purpose of the Study:
- To compare trends in hip osteotomy rates among children with CP in the United States before and after the introduction of national hip surveillance guidelines.
- To analyze changes in surgical management in response to established screening protocols.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 1997 to 2019.
- Identified hospital admissions for hip osteotomies in children (<20 years) with CP using ICD-9-CM and ICD-10-CM codes.
- Compared average monthly osteotomy rates before and after guideline publication using ANOVA, analyzing patient characteristics and length of stay.
Main Results:
- A total of 318,367 weighted CP admissions were recorded, with a 44% increase in annual CP hospitalizations.
- The average monthly hip osteotomy rate was highest before the Australian guidelines and significantly decreased after both Australian and American guideline publications.
- Patients in the post-AACPDM period were older and had longer hospital stays compared to earlier periods.
Conclusions:
- Reconstructive hip surgery rates declined in US children with CP, coinciding with the publication of national hip surveillance guidelines.
- Findings suggest an association between guideline publication and reduced osteotomy rates, though causality is not established.
- Potential factors include guideline adoption variability, care shifts, or evolving surgical practices, highlighting the need for formal guideline implementation.
Background:
Hip surveillance guidelines have been introduced by the Australian (AusACPDM, 2008) and American Academy for Cerebral Palsy and Developmental Medicine (AACPDM, 2016) to screen for hip displacement in children with cerebral palsy (CP). Whether these guidelines are associated with changes in surgical management remains unknown. This study compares trends in hip osteotomy rates among children with CP in the United States using a national database before and after the publication of national hip surveillance guidelines.
Methods:
International Classification of Diseases (ICD-9)-CM and ICD-10-CM codes were used to identify hospital admissions for hip osteotomies in children <20 years old with CP from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 1997 to 2019. Cases without an admission month were excluded. National estimates of CP-related hospital cases, osteotomy (acetabular, proximal femoral) rates, and hip dislocations were calculated using weighted variables provided by HCUP. The average monthly osteotomy rates were compared using one-way analysis of variance (ANOVA) for the periods before and after guideline establishments. Baseline patient characteristics were also analyzed using either chi-squared tests or one-way ANOVA.
Results:
From 1997 to 2019, 318,367 weighted CP admissions were recorded, demonstrating a 44% increase in the annual incidence of CP hospitalizations. Baseline patient characteristics for the periods January 1997 to December 2006 (preAusACPDM), January 2009 to September 2016 (post-AusACPDM, pre-AACPDM), and October 2016 to December 2019 (post-AACPDM) indicates that mean age and length-of-stay (LOS) increased significantly in the post-AACPDM period relative to the two prior time periods (P < 0.01). The average monthly osteotomy rate was highest in the pre-AusACPDM period and decreased significantly beginning in the post-AusACPDM period, reaching its lowest level in the post-AACPDM period (P < 0.01).
Conclusions:
Reconstructive hip surgery rates declined among children with CP treated in U.S. community hospitals represented in the KID database, temporally coinciding with publication of national hip surveillance guidelines. These findings demonstrate an association rather than a causal relationship and may reflect variation in guideline adoption, shifts in care to tertiary referral centers, or evolving surgical practices.
Key Concepts:
(1)Hip surveillance guidelines are screening tools for children with cerebral palsy.(2)Early detection of hip subluxation is crucial for timely orthopaedic interventions.(3)Children with cerebral palsy are undergoing hip osteotomies at older ages with longer stays in recent years.(4)Barriers may exist that prevent adherence to hip surveillance guidelines.(5)Formal guideline implementation may be necessary to improve timely interventions and outcomes.
Level Of Evidence:
IV.
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