Department of Orthopaedics, Boston Children's Hospital.
Harvard Medical School.
J Pediatr Orthop. 2022 Sep 1;42(8):e882-e888. doi: 10.1097/BPO.0000000000002219. Epub 2022 Jul 25.
Hip reconstruction surgery in patients with neurological complex chronic conditions (CCC) is associated with prolonged hospitalization and extensive resource utilization. This population is vulnerable to cognitive, developmental, and medical comorbidities which can increase length of stay (LOS). The aims of this study were to characterize barriers to discharge for a cohort of children with neurological CCC undergoing hip reconstruction surgery and to identify patient risk factors for prolonged hospitalization and delayed discharge.
Retrospective chart review of nonambulatory patients with neurological CCC undergoing hip reconstruction surgery between 2007-2016 was conducted. Hospitalization ≥1 day past medical clearance was characterized as delayed discharge. Barriers were defined as unresolved issues at the time of medical clearance and categorized as pertaining to the caregiver and patient education, durable medical equipment, postdischarge transportation/placement, and patient care needs.
The cohort of 116 patients was 53% male, 16% non-English speaking, and 49% Gross Motor Function Classification System (GMFCS) V with the mean age at surgery of 9.1±3.64 years. Median time from admission to medical clearance was 5 days with median LOS of 6 days. Approximately three-quarters of patients experienced delayed discharge (73%) with barriers identified for 74% of delays. Most prevalent barriers involved education (30%) and durable medical equipment (29%). Postdischarge transportation and placement accounted for 26% of barriers and 3.5 times longer delays ( P <0.001). Factors associated with delayed discharge included increased medical comorbidities ( P <0.05) and GMFCS V ( P <0.001). Longer LOS and medical clearance times were found for female ( P =0.005), older age ( P <0.001), bilateral surgery ( P =0.009), GMFCS V ( P =0.003), and non-English-speaking patients ( P <0.001).
Patients with neurological CCC frequently encounter postoperative barriers contributing to increased LOS and delayed discharge. Patients that may be at higher risk for prolonged hospitalization and greater resource utilization include those who are female sex, adolescent, GMFCS V, non-English speaking, have additional comorbidities, and are undergoing bilateral surgery. Standardized preoperative assessment of educational needs, perioperative equipment requirements, and posthospital transportation may decrease the LOS, reduce caregiver and patient burden/distress, cost, and ultimately reduce variation in care delivery.
Level III, Retrospective Case Series.
患有神经发育性复杂慢性疾病（CCC）的患者进行髋关节重建手术会导致住院时间延长和大量资源的使用。这类患者易出现认知、发育和医疗合并症，从而增加住院时间（LOS）。本研究的目的是描述一组接受髋关节重建手术的神经发育性 CCC 患儿出院障碍的特征，并确定导致住院时间延长和延迟出院的患者风险因素。
对 2007 年至 2016 年间接受髋关节重建手术的非活动能力神经发育性 CCC 患者进行回顾性图表审查。如果患者在达到医疗标准后住院时间超过 1 天，则被定义为延迟出院。障碍被定义为在达到医疗标准时未解决的问题，并分为与照顾者和患者教育、耐用医疗设备、出院后交通/安置以及患者护理需求有关的问题。
该队列包括 116 名患者，其中 53%为男性，16%为非英语患者，49%为粗大运动功能分级系统（GMFCS）V 级，手术时的平均年龄为 9.1±3.64 岁。从入院到达到医疗标准的中位时间为 5 天，中位 LOS 为 6 天。约四分之三的患者（73%）出现了延迟出院，其中 74%的延迟与障碍有关。最常见的障碍涉及教育（30%）和耐用医疗设备（29%）。出院后的交通和安置占障碍的 26%，延迟时间延长了 3.5 倍（P＜0.001）。与延迟出院相关的因素包括医疗合并症增加（P＜0.05）和 GMFCS V 级（P＜0.001）。女性（P=0.005）、年龄较大（P＜0.001）、双侧手术（P=0.009）、GMFCS V 级（P=0.003）和非英语患者（P＜0.001）的 LOS 和医疗 clearance 时间更长。
患有神经发育性 CCC 的患者经常会遇到术后障碍，导致 LOS 延长和延迟出院。可能需要更长的住院时间和更多资源的患者包括女性、青少年、GMFCS V 级、非英语患者、有其他合并症和接受双侧手术的患者。标准化术前评估教育需求、围手术期设备需求和出院后交通可能会缩短 LOS，减轻照顾者和患者的负担/痛苦、成本，并最终减少护理提供的差异。
III 级，回顾性病例系列。
