Preoperative Medical Evaluation and Optimisation of Children and Adolescents With Cerebral Palsy (GMFCS IV and V) With Complex Medical Comorbidity Undergoing Lower Limb Orthopaedic Surgery: Results of a Combined Rehabilitation Orthopaedic Paediatric Service.
TL;DR
There were minimal intraoperative complications, most occurring postoperatively, supporting the need for preoperative medical evaluation and shared care in the postoperative period.
Abstract
Aim
To describe preoperative medical evaluation, optimisation and acute postoperative outcomes in children and adolescents with cerebral palsy (CP) undergoing lower limb orthopaedic surgery managed in a Combined Rehabilitation Orthopaedic Paediatric Service (CROPS).
Methods
A retrospective medical record review of children and adolescents with CP managed in CROPS between 1 January 2019 and 1 June 2024. INCLUSION CRITERIA patients were between 0 and 19 years of age, had CP (Gross Motor Function Classification System IV or V) and had lower limb orthopaedic surgery.
Results
Fifty-three patients were included in the analysis. Median age at preoperative medical review was 8 years 9 months (range 2 years 2 months to 18 years 3 months, IQR 6 years 5 months). Twenty patients needed seizure management (n = 20/42, 37.7%), eighteen needed feeding input (n = 18/53, 34.0%), fourteen required respiratory optimisation (n = 14/53, 26.4%) and thirteen needed nutritional supplementation (n = 13/53, 24.5%) prior to surgery. There was only one intraoperative complication. Postoperatively, thirteen patients (n = 13/53, 24.5%) required antibiotics for respiratory infections, nine (n = 9/53, 17.0%) had feed intolerance, five (n = 53, 9.4%) developed pressure injuries and one (n = 1/53, 1.9%) developed a urinary tract infection.
Conclusions
There were minimal intraoperative complications, most occurring postoperatively, supporting the need for preoperative medical evaluation and shared care in the postoperative period.