Perioperative Outcomes Following Surgical Treatment of the Neuromuscular Hip: An Analysis of the National Surgical Quality Improvement Program—Pediatrics

Abstract

Background: Surgical treatment for neuromuscular (NM) hip subluxation or dislocation is undertaken to maintain functionality and decrease pain. Longterm complications are well described; however, the acute complication profile is poorly understood. Questions/Purpose: The aim of this study was to identify the rate of and risk factors for complications following surgical treatment of hip subluxation/dislocation, especially as it related to NM children. Methods: Hip reconstruction cases in patients with a NM diagnosis and non-NM patients were obtained from the 2015 American College of Surgeons NSQIP-Pediatric database by CPT code. 30-day postoperative complications were classified according to the Clavien-Dindo system as minor (grade 1 or 2) or major (grade 3+). Patient and surgical factors were assessed in univariate and multivariate logistic regression analyses for association with post-operative complications. Results: 1081 cases were identified (median age 7.7, 55% female), of whom 420 (39%) had a NM diagnosis. Overall complication rate was significantly higher in NM patients (33% vs. 19%, p < 0.001). Numerous factors were associated with postoperative complication on univariate analysis. Multivariate analysis identified NM diagnosis (OR 1.5), age > 6 years (OR 1.5), or pelvic osteotomy (OR 1.9) as independent risk factors for complication. Conclusion: In pediatric reconstructive hip surgery requiring pelvic osteotomy, a NM diagnosis is associated with an increased risk of 30-day postoperative complications. Older age and increasing surgical complexity were also independently associated with complications. These findings support special attention for the older patients undergoing concomitant pelvic osteoHow to cite this paper:

Pneumonia after hip surgery in children with neurological complex chronic conditions

“…Postoperative pneumonia rates after hip surgery in children with neurological CCC have been reported in several retrospective studies. The rates range between 1.4% and 13.2%, 6,11,13,21,22 with our study reporting a rate of 1.6%, which falls within the reported range. The variability in pneumonia rates across these studies can be explained by the lack of diagnostic criteria for pneumonia, 6,11,21,22 smaller sample sizes (44-120 patients), 6,11,21 and conducted over 25 years ago when care options were more limited.…”

“…The rates range between 1.4% and 13.2%, 6,11,13,21,22 with our study reporting a rate of 1.6%, which falls within the reported range. The variability in pneumonia rates across these studies can be explained by the lack of diagnostic criteria for pneumonia, 6,11,21,22 smaller sample sizes (44-120 patients), 6,11,21 and conducted over 25 years ago when care options were more limited. 11,21 A significant limitation of the previous literature is that only one of the studies specified a time period for when the diagnosis of the pneumonia was made after surgery, 13 limiting a fuller understanding of its precipitating factors.…”

“…In this study, having a pelvic osteotomy and a greater number of coexisting chronic conditions were predictors of developing postoperative pneumonia. A retrospective study of 1081 children in the American College of Surgery National Surgery Quality Improvement Program (NSQIP)‐Pediatric database supported our finding and identified having a concomitant pelvic osteotomy as a risk factor for the development of a postoperative complication after hip surgery in children with neurological disorders 22 . However, this study examined all complications within 30 days of the surgery but did not focus specifically on pneumonia.…”

“…A retrospective study of 1081 children in the American College of Surgery National Surgery Quality Improvement Program (NSQIP)-Pediatric database supported our finding and identified having a concomitant pelvic osteotomy as a risk factor for the development of a postoperative complication after hip surgery in children with neurological disorders. 22 However, this study examined all complications within 30 days of the surgery but did not focus specifically on pneumonia. Berry et al identified that having four or more coexisting chronic conditions was associated with increased postoperative resource utilization after hip surgery in children with neurological CCC.…”