Department of Orthopaedic Surgery.
Harvard Medical School, Boston Children's Hospital, Boston, MA.
J Pediatr Orthop. 2020 Nov/Dec;40(10):e972-e977. doi: 10.1097/BPO.0000000000001643.
The purpose of this study is to examine the relationship between preoperative comorbidities, surgical complications, and length of stay (LOS) after hip reconstruction in nonambulatory children with cerebral palsy (CP).
This single-center retrospective cohort study included 127 patients undergoing hip surgery between 2007 and 2016 who were diagnosed with CP (GMFCS IV/V). The cohort was 54% Gross Motor Function Classification System (GMFCS) V with an average age at surgery of 9 years (range, 3-19 y). Preoperative comorbidities included: presence of a gastrostomy tube, respiratory difficulty requiring positive-pressure ventilation or tracheostomy, history of seizures, and nonverbal status. Complications were dichotomized into major and minor complications according to severity. Multivariable general linear modeling was used to identify factors associated with complications and prolonged LOS.
The median LOS in the hospital was 6 days (intequartile range, 5-9 d). The majority of procedures (72%) involved both the femur and acetabulum and 82% of surgeries were performed bilaterally. Patients who experienced a major complication were mostly GMFCS level V and were more likely to spend time in intensive care unit than postanesthetic care unit (P=0.001). Multivariable analysis for a major complication determined that the addition of each comorbid risk fact increased the odds of developing a major complication by 2.6 times (odds ratio, 2.64; 95% confidence interval, 1.56-4.47; P<0.001) regardless of GMFCS level. Multivariable analysis for prolonged LOS determined that major complications (P<0.001), bilaterality (P=0.01), age (P=0.02), female sex (P=0.01), and GMFCS V (P<0.001) were all factors that increased LOS. Migration percentage, acetabular index odds ratio, and pelvic obliquity were not associated with prolonged LOS or the presence of a major complication.
From our analysis, the authors found that a patient's premorbid comorbidities were more predictive of the likelihood of sustaining a major complication than their GMFCS level. Identifying high-risk patients preoperatively may help reduce complications and LOS, which ultimately will improve the quality of care the authors deliver to nonambulatory children with CP undergoing hip reconstruction surgery.
Level III-retrospective cohort study.
本研究旨在探讨术前合并症、手术并发症与脑瘫（CP）非卧床儿童髋关节重建术后住院时间（LOS）之间的关系。
这是一项单中心回顾性队列研究，纳入了 2007 年至 2016 年间行髋关节手术的 127 名 CP（GMFCS IV/V）患儿。队列中 54%的患儿为 GMFCS V 级，平均手术年龄为 9 岁（3-19 岁）。术前合并症包括胃造口管、需要正压通气或气管切开的呼吸困难、癫痫发作史和非语言状态。根据严重程度，并发症分为主要和次要并发症。采用多变量广义线性模型确定与并发症和 LOS 延长相关的因素。
住院期间 LOS 的中位数为 6 天（四分位距，5-9d）。大多数手术（72%）同时涉及股骨和髋臼，82%的手术为双侧。发生主要并发症的患者主要为 GMFCS 水平 V，且比术后麻醉恢复室（postanesthetic care unit，PACU）更可能在重症监护病房（intensive care unit，ICU）中度过（P=0.001）。主要并发症的多变量分析确定，每增加一个合并症危险因素，发生主要并发症的几率增加 2.6 倍（优势比，2.64；95%置信区间，1.56-4.47；P<0.001），而与 GMFCS 水平无关。LOS 延长的多变量分析确定，主要并发症（P<0.001）、双侧性（P=0.01）、年龄（P=0.02）、女性（P=0.01）和 GMFCS V（P<0.001）均为延长 LOS 的因素。髋臼指数比值和骨盆倾斜度与 LOS 延长或主要并发症的发生无关。
从我们的分析中，作者发现患者术前合并症比其 GMFCS 水平更能预测发生主要并发症的可能性。术前识别高风险患者可能有助于减少并发症和 LOS，从而最终提高为接受髋关节重建手术的非卧床 CP 患儿提供的护理质量。
III 级-回顾性队列研究。
