Single-event multilevel surgery in cerebral palsy

Abstract

The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons. A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared. In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons ( P = 0.03). Decreased operative time was associated with an estimated savings of $2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P = 0.11). Decreased operative time was associated with an estimated savings of $1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS. Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP. Level of Evidence: Level III

Use of Hyperselective Neurectomy in the Management of the Pediatric Spastic Upper Extremity

“…Single-event multilevel surgery (SEMLS) is preferred in the upper limb similar to lower limb surgery in CP patients. 18 Historically, this would typically involve some combination of the following: musculotendinous fractional or z-lengthenings as indicated for the agonistic deforming force muscles, tendon transfers to strengthen and improve antagonistic muscle function, and/or contracture releases and joint stabilization procedures. 9 The specific type and number of procedures performed are highly dependent on the patient's goals, clinical evaluation, and baseline functional capacity.…”

“…SEMLS has been shown in the literature to not only decrease operative time and operating room costs but also improve outcomes in patients with spasticity conditions. 18,25 Moreover, the benefit of decreasing anesthetic risk for the child by avoiding multiple surgeries is of great value. 26 One team performed the selective denervation of her biceps and brachialis proximally while positioned in the axillae; meanwhile, the other surgical team performed a left wrist fusion with proximal row carpectomy, bone grafting from carpal bone donors, and plating via a dorsal approach with the arm resting on a fluoroscopic hand table (Figure 4).…”

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

“…1 Another strategy to optimize perioperative outcomes can be the incorporation of a co-surgeon. [10][11][12][13][14][15] With this modality, critical steps of complex microsurgical reconstructive procedures can occur concurrently rather than in sequence. 1 Reduced operative time, shorter length of stay, and lesser healthcare-associated costs have been reported with a co-surgeon model for the ablative segment of breast oncologic procedures (mastectomy), [10][11][12] whereas reduced estimated blood loss, 14,15 complication rates, 14 requirements of narcotics, 15 operative time, and improved operating room utilization costs have been reported in the field of orthopedic and neurological surgery with a co-surgeon.…”

“…1 Reduced operative time, shorter length of stay, and lesser healthcare-associated costs have been reported with a co-surgeon model for the ablative segment of breast oncologic procedures (mastectomy), [10][11][12] whereas reduced estimated blood loss, 14,15 complication rates, 14 requirements of narcotics, 15 operative time, and improved operating room utilization costs have been reported in the field of orthopedic and neurological surgery with a co-surgeon. [13][14][15] The purpose of this review was to evaluate the role of a co-surgeon model for microvascular breast reconstruction (MBR) in plastic surgery. Our research question was as follows: In adult patients undergoing MBR (population), can a co-surgeon model (intervention) when compared with a single microsurgeon model (comparison) decrease the surgical time, length of stay, the rate of complications, and healthcare-associated costs (outcome) during the perioperative period (time)?…”

“…1 Another strategy to optimize perioperative outcomes can be the incorporation of a co-surgeon. 10–15 With this modality, critical steps of complex microsurgical reconstructive procedures can occur concurrently rather than in sequence. 1…”