Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, D.C.
Department of Orthopaedic Surgery, Children's National Hospital Washington, D.C.
J Pediatr Orthop. 2022 Oct 1;42(9):e925-e931. doi: 10.1097/BPO.0000000000002216. Epub 2022 Aug 2.
Despite the many surgical interventions available for spastic hip dysplasia in children with cerebral palsy, a radical salvage hip procedure may still ultimately be required. The purpose of this study was to assess whether race is an independent risk factor for patients with cerebral palsy to undergo a salvage hip procedure or experience postoperative complications for hip dysplasia treatment.
This is a retrospective cohort analysis utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database from 2012 to 2019. International Classification of Diseases, 9th and 10th Revisions, Clinical Modifications (ICD-9-CM, ICD-10-CM), and current procedural terminology (CPT) codes were used to identify patients with cerebral palsy undergoing hip procedures for hip dysplasia and to stratify patients into salvage or reconstructive surgeries.
There was a total of 3906 patients with cerebral palsy between the ages of 2 and 18 years undergoing a procedure for hip dysplasia, including 1995 (51.1%) White patients, 768 (19.7%) Black patients, and 1143 (29.3%) patients from other races. Both Black ( P =0.044) and White ( P =0.046) races were significantly associated with undergoing a salvage versus a reconstructive hip procedure, with Black patients having an increased risk compared to White patients [adjusted odds ratio (OR) 1.77, confidence interval (CI) 1.02-3.07]. Only Black patients were found to have an increased risk of any postoperative complication compared to White patients, with an adjusted OR of 1.26 (CI 1.02-1.56; P =0.033). Both White ( P =0.017) and black ( P =0.004) races were found to be significantly associated with medical complications, with Black patients having an increased risk (adjusted OR 1.43, CI 1.12-1.84) compared to White patients. There were no significant findings between the race and risk of surgical site complications, unplanned readmissions, or reoperations.
This study demonstrates that patient race is an independent association for the risk of pediatric patients with cerebral palsy to both undergo a salvage hip procedure and to experience postoperative medical complications, with Black patients having an increased risk compared to White.
Level III Retrospective Cohort Study.
尽管针对脑瘫儿童的痉挛性髋关节发育不良有许多外科干预措施，但最终可能仍需要进行激进的挽救性髋关节手术。本研究旨在评估种族是否是脑瘫患者接受挽救性髋关节手术或接受髋关节发育不良治疗术后并发症的独立危险因素。
这是一项利用美国外科医师学会国家手术质量改进计划（NSQIP）儿科数据库进行的回顾性队列分析，时间范围为 2012 年至 2019 年。国际疾病分类，第 9 版和第 10 版修订版，临床修正（ICD-9-CM、ICD-10-CM）和当前手术术语（CPT）代码用于识别接受髋关节手术治疗髋关节发育不良的脑瘫患者，并将患者分层为挽救性或重建性手术。
共有 3906 名 2 至 18 岁的脑瘫患者接受了髋关节手术，其中 1995 名（51.1%）为白人患者，768 名（19.7%）为黑人患者，1143 名（29.3%）为其他种族患者。黑人（P=0.044）和白人（P=0.046）种族均与接受挽救性与重建性髋关节手术显著相关，与白人患者相比，黑人患者的风险增加[校正比值比（OR）1.77，置信区间（CI）1.02-3.07]。仅黑人患者与白人患者相比，术后发生任何并发症的风险增加，校正 OR 为 1.26（CI 1.02-1.56；P=0.033）。白人（P=0.017）和黑人（P=0.004）种族均与医疗并发症显著相关，与白人患者相比，黑人患者的风险增加（校正 OR 1.43，CI 1.12-1.84）。种族与手术部位并发症、计划外再入院或再次手术的风险之间无显著相关性。
本研究表明，患者种族是脑瘫患儿接受挽救性髋关节手术和术后发生医疗并发症的独立危险因素，黑人患者的风险高于白人患者。
III 级回顾性队列研究。
