DiFazio Rachel, Vessey Judith A, Miller Patricia, Van Nostrand Kelsey, Snyder Brian
*Orthopedic Center, Boston Children's Hospital ‡Boston Children's Hospital, Boston †William F. Connell School of Nursing, Boston College, Chestnut Hill, MA.
J Pediatr Orthop. 2016 Jan;36(1):56-62. doi: 10.1097/BPO.0000000000000404.
Little is known about the postoperative complications experienced by patients with severe cerebral palsy (CP) (GMFCS IV-V) compared with otherwise healthy patients with hip pathology requiring surgery. The purpose of this study was to determine whether differences exist between these 2 groups with respect to the incidence, type, and severity of complications. In addition, we evaluated the risk factors for complications and the number and cost of additional visits, hospital admissions, and repeat surgeries due to complications.
Retrospective matched cohort study of 55 patients aged 3 to 25 years with severe CP and 55 non-CP patients with hip dysplasia who underwent hip osteotomies (2000 to 2012). Postoperative complications were evaluated using the adapted Clavien-Dindo classification system. Binary and ordinal logistic regressions were used to identify risk factors for complications. The number and cost of unplanned visits, admissions, and surgeries were calculated.
CP patients experienced almost twice as many complications as the non-CP patients (P=0.004). All types of complications occurred in both groups except orthopaedic complications (P<0.001) were more frequent in the non-CP group. CP patients were 82% more likely to develop a complication compared with non-CP patients (relative risk=1.82; 95% confidence interval=1.21 to 2.76). The severity of complications was comparable with no significant differences in the relative distribution between the groups. There was a significant difference between groups for the number of unplanned clinic and emergency department visits (P≤0.001). The average cost for treating a complication was $1857.00 for CP and $1800.00 for non-CP (P=0.72).
Although patients with severe CP requiring hip surgery have a 65% chance of experiencing at least 1 postoperative complication compared with 36% of non-CP patients, most of the complications were medical in the CP patients (n=46, 83%) as opposed to the non-CP patient who experienced predominantly orthopaedic complications (59%). When these complications occur the associated costs are greater for CP patients as a whole, but are relatively similar per patient.
Level III—Prognostic, case-control study.
与患有需要手术的髋关节病变的健康患者相比，关于重度脑瘫（CP）（粗大运动功能分级系统IV - V级）患者术后并发症的情况知之甚少。本研究的目的是确定这两组患者在并发症的发生率、类型和严重程度方面是否存在差异。此外，我们评估了并发症的危险因素以及因并发症导致的额外就诊次数、住院次数和再次手术的次数及费用。
对55例年龄在3至25岁的重度CP患者和55例患有髋关节发育不良的非CP患者（2000年至2012年接受髋关节截骨术）进行回顾性匹配队列研究。使用改良的Clavien - Dindo分类系统评估术后并发症。采用二元和有序逻辑回归来确定并发症的危险因素。计算计划外就诊、住院和手术的次数及费用。
CP患者的并发症发生率几乎是非CP患者的两倍（P = 0.004）。除骨科并发症外，两组均出现了所有类型的并发症（P < 0.001），非CP组的骨科并发症更为常见。与非CP患者相比，CP患者发生并发症的可能性高82%（相对风险 = 1.82；95%置信区间 = 1.21至2.76）。并发症的严重程度相当，两组之间的相对分布无显著差异。两组在计划外门诊和急诊科就诊次数上存在显著差异（P≤0.001）。CP患者治疗并发症的平均费用为1857.00美元，非CP患者为1800.00美元（P = 0.72）。
尽管需要髋关节手术的重度CP患者发生至少1种术后并发症的几率为65%，而非CP患者为36%，但CP患者的大多数并发症为内科性（n = 46，83%），而非CP患者主要发生骨科并发症（59%）。当这些并发症发生时，CP患者总体相关费用更高，但每位患者的费用相对相似。
III级——预后性病例对照研究。
