Butler Liam R, Dominy Calista L, White Christopher A, Mengsteab Paulos, Lin Elaine, Allen Abigail K, Ranade Sheena C
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
J Orthop. 2023 Mar 2;38:14-19. doi: 10.1016/j.jor.2023.03.002. eCollection 2023 Apr.
Spastic hip dysplasia is a common complication of cerebral palsy in children, and surgical intervention is usually warranted. While current literature has primarily analyzed single institution outcomes, this study utilized a national database to describe readmission rates and factors correlated with readmission for children with cerebral palsy undergoing hip surgery in order to treat this population more effectively.
This study queried the Nationwide Readmissions Database (2014-2018) for pediatric patients with cerebral palsy who underwent hip surgery. Patient demographics, pre-operative comorbidities, length of stay (LOS), treatment complications, and readmission data were collected for each patient and analyzed with inferential statistics.
Of the 1225 patients included, the average age was 9.3 ± 3.8 years and 42.8% were female. Approximately 26.3% patients had a prolonged LOS (≥5 days) and 14.2% patients required readmission within 90-days of surgery. Medical complications, cardiac arrhythmias, and iron deficiency anemia were all significantly associated with elongated LOS as well as 90-day readmission. Patients with Medicaid were more frequently associated with an inpatient medical complication and the overall complication rate was 5.5%.
While current literature has analyzed common risk factors and complications associated with hip surgery in the pediatric cerebral palsy patient, this study identifies a national readmission rate (14.2%) as well as preoperative comorbidities associated with readmission within 90-days and/or elongated LOS. Notably, complications are more frequently associated with patients using Medicaid. These results further exemplify the importance of equitable access to care and thorough selection of pediatric cerebral palsy patients appropriate for hip surgery.
痉挛性髋关节发育不良是儿童脑瘫的常见并发症，通常需要进行手术干预。虽然目前的文献主要分析了单一机构的治疗结果，但本研究利用国家数据库来描述脑瘫患儿髋关节手术的再入院率以及与再入院相关的因素，以便更有效地治疗这一群体。
本研究查询了全国再入院数据库（2014 - 2018年）中接受髋关节手术的脑瘫患儿。收集了每位患者的人口统计学信息、术前合并症、住院时间（LOS）、治疗并发症和再入院数据，并进行了推断统计分析。
纳入的1225例患者中，平均年龄为9.3±3.8岁，42.8%为女性。约26.3%的患者住院时间延长（≥5天），14.2%的患者在术后90天内需要再次入院。医疗并发症、心律失常和缺铁性贫血均与住院时间延长以及90天再入院显著相关。医疗补助患者更常出现住院医疗并发症，总体并发症发生率为5.5%。
虽然目前的文献分析了小儿脑瘫患者髋关节手术相关的常见风险因素和并发症，但本研究确定了全国范围内的再入院率（14.2%）以及与90天内再入院和/或住院时间延长相关的术前合并症。值得注意的是，并发症更常与使用医疗补助的患者相关。这些结果进一步证明了公平获得医疗服务以及对适合髋关节手术的小儿脑瘫患者进行全面筛选的重要性。
