Wren Tishya A L, Kalisvaart Michael M, Ghatan Christine E, Rethlefsen Susan A, Hara Reiko, Sheng Minya, Chan Linda S, Kay Robert M
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
J Pediatr Orthop. 2009 Sep;29(6):558-63. doi: 10.1097/BPO.0b013e3181b2f8c2.
The purpose of this study was to determine the effects of clinical gait analysis (GA) on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery these children undergo.
A retrospective review identified all ambulatory patients with CP who had undergone lower extremity orthopaedic surgery at our hospital from 1991 to 2005 with at least a 6-month follow-up. The patients were grouped into those who had undergone GA before their index surgery (GA group, N=313) and those who had not (NGA group, N=149). The groups were compared in terms of the number of procedures during index surgery and subsequent surgeries and the direct costs associated with these surgeries. Costs were calculated in US dollars by using a standardized protocol including fees for the surgeon, anesthesia, operating room, hospital stay, physical therapy, and GA.
Patients in the GA group were significantly older and less functionally involved, had their first surgery in later years, and had a shorter follow-up than patients in the NGA group (P<0.001). Adjusting for these differences, patients in the GA group had more procedures (GA: 5.8, NGA: 4.2; P<0.001) and higher cost (GA: $43,006, NGA: $35,215; P<0.001) during index surgery, but less subsequent surgery. A higher proportion of patients went on to additional surgery in the NGA group (NGA: 32%, GA: 11%; P<0.001), with more additional surgeries per person-year (NGA: 0.3/person-year, GA: 0.1/person-year; P<0.001) resulting in higher additional costs (NGA: $3009/person-year, GA: $916/person-year; P<0.001). The total number of procedures (GA: 2.6/person-year, NGA: 2.3/person-year; P=0.22) and cost (GA: $20,448/person-year, NGA: $19,535/person-year; P=0.58) did not differ significantly between the 2 groups.
Clinical GA is associated with a lower incidence of additional surgery, resulting in lesser disruption to patients' lives. This finding has not been shown before and may assist patients, physicians, policy makers, and insurance companies in assessing the role of GA in the care of ambulatory children with CP.
Level III, retrospective comparative study.
本研究旨在确定临床步态分析（GA）对门诊脑瘫（CP）患儿护理费用以及这些患儿接受手术量的影响。
一项回顾性研究确定了1991年至2005年在我院接受下肢骨科手术且至少随访6个月的所有门诊CP患者。患者被分为在首次手术前接受过GA的患者（GA组，N = 313）和未接受过GA的患者（非GA组，N = 149）。比较两组在首次手术及后续手术中的手术次数以及与这些手术相关的直接费用。费用以美元计算，采用标准化方案，包括外科医生、麻醉、手术室、住院、物理治疗和GA的费用。
GA组患者比非GA组患者年龄显著更大、功能障碍程度更低，首次手术时间更晚，随访时间更短（P < 0.001）。校正这些差异后，GA组患者在首次手术期间的手术次数更多（GA组：5.8次，非GA组：4.2次；P < 0.001），费用更高（GA组：43,006美元，非GA组：35,215美元；P < 0.001），但后续手术较少。非GA组中进行额外手术的患者比例更高（非GA组：32%，GA组：11%；P < 0.001），每人每年的额外手术次数更多（非GA组：0.3次/人年，GA组：0.1次/人年；P < 0.001），导致额外费用更高（非GA组：3009美元/人年，GA组：916美元/人年；P < 0.001）。两组之间的总手术次数（GA组：2.6次/人年，非GA组：2.3次/人年；P = 0.22）和费用（GA组：20,448美元/人年，非GA组：19,535美元/人年；P = 0.58）差异不显著。
临床GA与额外手术发生率较低相关，从而对患者生活的干扰较小。这一发现此前尚未见报道，可能有助于患者、医生、政策制定者和保险公司评估GA在门诊CP患儿护理中的作用。
III级，回顾性比较研究。
