TITLE:
Perioperative Outcomes Following Surgical Treatment of the Neuromuscular Hip: An Analysis of the National Surgical Quality Improvement Program—Pediatrics
AUTHORS:
K. Aaron Shaw, Justin M. Hire, David S. Kauvar, Dana Olszewski, Joshua S. Murphy
KEYWORDS:
Hip Subluxation, Hip Dislocation, Surgical Complications, Pediatric, NSQIP-P
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.8 No.1,
January
22,
2018
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 relate 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 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 osteotomies to minimize complication rate.