Comparison of Staged Versus Same-day Bilateral Hip Surgery in Nonambulatory Children With Cerebral Palsy

Hip reconstruction in children with cerebral palsy: does magnitude of surgery influence complications and outcomes?

Children with cerebral palsy (CP) and neuromuscular hip dysplasia (NMHD) frequently require hip reconstruction including femoral and pelvic osteotomies. Outcomes and complications in CP patients with NMHD who underwent varying degrees of hip reconstruction surgeries were examined. Ninety-nine patients with a diagnosis of CP who underwent surgical management of NMHD over a 15-year period (2005-2020) were reviewed. Three patient cohorts with varying degrees of surgery were analyzed including: (1) unilateral femoral osteotomy with pelvic osteotomy; (2) bilateral femoral osteotomy with unilateral pelvic osteotomy; and (3) simultaneous bilateral femoral osteotomy and bilateral pelvic osteotomy. Data points included operative (OR) time, length of stay (LOS), estimated blood loss (EBL), and transfusion requirement. Complications during the perioperative and postoperative periods were identified and graded by severity. Increased EBL, need for transfusion, OR time, and LOS were observed more frequently in patients undergoing bilateral reconstruction. Complication rates were high for all three cohorts, with 87% of cases in the bilateral pelvic osteotomy cohort experiencing ≥1 complication. However, 90% of these were considered grade I or II and required no or minimal intervention. The average postoperative migration index at final follow-up for treated hips was significantly less in bilateral pelvic osteotomy cases. Patients with CP and bilateral NMHD can be safely managed with bilateral simultaneous comprehensive reconstruction. The data presented in this study can help both surgeons and families anticipate a more accurate postoperative course. Level of evidence: III.

Risk factors for 90-day readmission and prolonged length of stay after hip surgery in children with cerebral palsy

Objective

Spastic hip dysplasia is a common complication of cerebral palsy in children, and surgical intervention is usually warranted. While current literature has primarily analyzed single institution outcomes, this study utilized a national database to describe readmission rates and factors correlated with readmission for children with cerebral palsy undergoing hip surgery in order to treat this population more effectively.

Methods

This study queried the Nationwide Readmissions Database (2014-2018) for pediatric patients with cerebral palsy who underwent hip surgery. Patient demographics, pre-operative comorbidities, length of stay (LOS), treatment complications, and readmission data were collected for each patient and analyzed with inferential statistics.

Results

Of the 1225 patients included, the average age was 9.3 ± 3.8 years and 42.8% were female. Approximately 26.3% patients had a prolonged LOS (≥5 days) and 14.2% patients required readmission within 90-days of surgery. Medical complications, cardiac arrhythmias, and iron deficiency anemia were all significantly associated with elongated LOS as well as 90-day readmission. Patients with Medicaid were more frequently associated with an inpatient medical complication and the overall complication rate was 5.5%.

Conclusions

While current literature has analyzed common risk factors and complications associated with hip surgery in the pediatric cerebral palsy patient, this study identifies a national readmission rate (14.2%) as well as preoperative comorbidities associated with readmission within 90-days and/or elongated LOS. Notably, complications are more frequently associated with patients using Medicaid. These results further exemplify the importance of equitable access to care and thorough selection of pediatric cerebral palsy patients appropriate for hip surgery.

Rates of readmission and reoperation following pelvic osteotomy in adolescent patients: a database study evaluating the pediatric health information system

Rates and reasons for readmission and reoperation following adolescent pelvic osteotomy are not well-defined. This study aimed to (1) determine 30-day and 90-day readmission rates and the 2-year reoperation rate after pelvic osteotomy in adolescents and (2) identify reasons for readmission and reoperation. The Pediatric Health Information System database was queried between 10 January 2015 and 1 January 2020 for patients meeting selected International Classification of Diseases (ICD-10) procedure and diagnosis codes relating to pelvic osteotomies. Readmission rates were calculated within 30 and 90 days from index osteotomy. The ipsilateral reoperation rate was calculated within 2 years from index osteotomy. Reasons for these outcomes were identified. Univariate and multivariate analyses were utilized to identify readmission risks. Of 1475 patients, 5.4% and 9.2% were readmitted within 30 and 90 days, respectively. Reasons for readmission were consistent across both time points and included infection, hip-related orthopedic conditions and neurologic conditions. Younger age (OR 0.83, 95% CI: 0.76, 0.89; P < 0.0001) and male sex (OR 1.77, 95% CI: 1.23–2.54; P = 0.002) were predictive of readmission within 90 days. The 2-year reoperation rate was 32.1%, of which 79.8% underwent reoperation for hardware removal, 17.7% for revision and 1.3% for hip replacement. 30-day readmission, 90-day readmission and 2-year reoperation rates after adolescent pelvic osteotomy were 5.4%, 9.2% and 32.1%, respectively. Younger age and male sex were predictive of 90-day readmission. Most ipsilateral reoperations were for hardware removal. Understanding readmission and reoperation risks following pelvic osteotomy can benefit patient counseling and improve expectations of post-surgical outcomes.

Level of Evidence:

IV, case series.