Neonates presenting with hypothermia have a substantial risk for SBI or other significant pathology. This population merits further investigation; a multicenter prospective study should be conducted to better understand associations between risk factors and outcomes.

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Background:The study objective was to determine whether a multidisciplinary, comprehensive preoperative assessment and co-management structure improved the perioperative course in children with medical complexity (CMC) undergoing orthopaedic surgery.Methods: Utilizing QI methodology, outcome measures were compared from pre-implementation across 2 PDSA cycles. By PDSA cycle 2, CMC were seen for a pre-surgical optimization review by the pediatric nurse practitioner (PNP), followed by coordination with the pediatric complex care team and the patient's sub-specialty providers. Gaps in the patient's care that would limit clearance for surgery, as identified during the optimization review, were addressed and then comprehensive care plans were created preoperatively. Patients were treated postoperatively with a co-management framework between the pediatric medical management teams and orthopaedic services.Results: There were 90 children who met the inclusion criteria for retrospective chart review. Cerebral palsy was the leading primary diagnosis (n=62). Posterior spinal fusion (n=37) and hip containment (n=37) procedures were the most frequent procedures. Following implementation of our preoperative review process, a statistically significant number of patients were found to have gaps in care (n=21; p=<0.00001). Additionally, patients were 1.92 times more likely to receive preoperative anticipatory guidance during PDSA cycle 2 when compared to pre-implementation (p=< 0.00001). Length of stay for children was relatively stable across PDSA cycles. There was a decreased time to resumption of enteral feeds by 51.3% (p=0.007743) following full program implementation. Most notably, there was elimination of rapid responses and transfers to higher level of care, and there was a 42.8% reduction in postoperative complications during PDSA cycle 2. Conclusion:A preoperative optimization program and co-management model improve the CMC's surgical readiness and postoperative outcomes.