Classifying Adverse Events Following Lower Limb Orthopaedic Surgery in Children With Cerebral Palsy: Reliability of the Modified Clavien-Dindo System

Zhou, Leena; Willoughby, Kate; Strobel, Natalie; Thomason, Pam; Gallagher, Charles G.; Harambasic, M.; Khot, Abhay; Graham, H. Kerr

doi:10.1097/bpo.0000000000001233

Cited by 17 publications

(13 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to demographics, details about postoperative complications related to the SPLATT were collected and rated according to the Modified Clavien-Dindo (MCD) complication rating system. 21 - 23 Postoperative recurrence of pes varus, development of valgus foot deformities, need for, and the type of revision surgeries were also recorded.…”

Section: Methodsmentioning

confidence: 99%

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series

et al. 2020

View full text Add to dashboard Cite

Introduction: The study purpose was to determine the safety/efficacy of a split anterior tibialis tendon transfer (SPLATT) to the peroneus tertius or brevis in children with static encephalopathy and varus feet. Methods: A retrospective review of short- and long-term complications, change in ankle range of motion, strength, and gait kinematics. Predictors of postoperative varus or valgus were examined. Results: One hundred thirty-three patients were included (average age [SD] 10.3 [3.7]), with an average follow-up of 3.9 (3.4) years. Forefoot/hindfoot eversion range of motion improved ( P ≤ 0.05), dorsiflexor strength was maintained or improved in 76.9% of patients, and dorsiflexion in swing phase was maintained. Complications occurred in 6 of 133 patients (4.5%) and included 1 transfer failure, 1 wound dehiscence, and four pressure areas from casts. Successful correction was achieved in 77% of patients. Later onset of recurrent varus (14.4%, 10.6% requiring revision surgery) and pes valgus (8.7%, 4.8% requiring revision surgery) occurred. The length of the follow-up predicted the development of the pes valgus (odds ratio 1.28, 95% CI 1.0 to 1.6). Discussion: SPLATT to the peroneus tertius or brevis is effective, and complications are rare. Subsequent valgus or recurrent varus deformities may occur, possibly requiring repeat surgery.

show abstract

Section: Methodsmentioning

confidence: 99%

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Postoperative complications, as recorded in patients' EMR, were surveyed and severity categorized according to the previously validated modified Clavien-Dindo classification. 11,20,21 Most complications were minor, requiring only nursing attention and/or pharmacologic intervention (Clavien-Dindo grade 1 or 2), and only 1 patient required surgical intervention (grade 3) due to large skin blisters for irrigation and debridement (Table 2). Multivariate logistic regression indicated that postoperative complications were dependent on the GMFCS level rather than a mode of regional analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…The modified Clavien-Dindo classification is a validated scale graded from 1 to 5 based on increasing severity (with 1 being complications managed with minor modifications to routine postoperative care and 5 being death) and is used to assess surgical outcomes and has been shown to have high interrater and intrarater reliability for classifying adverse events in children with CP undergoing lower limb surgery (aim 1). 11 Morphine milligram equivalents (MME) served as the surrogate metric for pain and were derived using standard conversion factors applied to all perioperative opioids consumed by each patient (aim 2). 12 Postoperative pain was managed by the institution's Acute Pain Service using standardized, weight-based protocols with a combination of local anesthetic infusions (as appropriate), routine nonopioid analgesics (acetaminophen, ketorolac, ibuprofen), and adjuncts (gabapentinoids, antispasmodics) around the clock, and rescue opioids as indicated.…”

Section: Methodsmentioning

confidence: 99%

Epidural Analgesia Versus Lumbar Plexus Blockade After Hip Reconstruction Surgery in Children With Cerebral Palsy and Intrathecal Baclofen Pumps: A Comparison of Safety and Efficacy

Samineni¹,

Eklund

Miller³

et al. 2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Epidural analgesia is commonly used for pain control after reconstructive hip surgery, but its use is controversial in the presence of an intrathecal baclofen pump (ITB). The purpose of this retrospective study was to investigate the rate of serious anesthetic and postoperative complications as well as the efficacy of epidural analgesia compared with lumbar plexus blocks (LPBs) for pain management after neuromuscular hip reconstruction in children with cerebral palsy (CP) and ITB. Methods: Pediatric patients with CP and ITB undergoing hip reconstructive surgery from 2010 to 2019 were retrospectively identified. Patients receiving epidural analgesia were compared with those receiving LPB. Morphine milligram equivalents per kilogram were used as a surrogate measure for pain-related outcomes, as pain scores were reported with wide ranges (eg, 0 to 5/10), making it unfeasible to compare them across the cohort. Postoperative complications were graded using the modified Clavien-Dindo classification. Results: Forty-four patients (26/44, 59% male) underwent surgery at an average age of 10.3 years (SD = 3.4 y, range: 4 to 17 y). The majority utilized LPB (28/44, 64%) while the remaining utilized epidural (16/44, 36%). There were no differences in rates of serious complications, including no cases of ITB malfunction, damage, or infection. During the immediate postoperative course, patients who received LPB had higher morphine milligram equivalents per kilogram requirements than patients who received epidural analgesia. Conclusions: In patients with CP undergoing hip reconstruction surgery with an ITB in situ, epidural anesthesia was associated with improved analgesia compared with LPB analgesia, with a similar risk for adverse outcomes. Epidural catheters placed using image-guided insertion techniques can avoid damage to the ITB catheter while providing effective postoperative pain control without increasing rates of complications in this complex patient population. Level of Evidence: Level III.

show abstract

“…Complications were documented during the postoperative course and graded according to the modified Clavien-Dindo classification of surgical complications [19]. Just recently Zhou et al have shown that this system has a high level of reliability even if applied for children with CP who are known to have more frequent adverse events as well as a different profile of complications [20]. Five hips had to be excluded due to inadequate post-operative radiographic follow up.…”

Section: Methodsmentioning

confidence: 99%

Risk Profile of Bony Intervention for Hip Displacement in our Youngest Cohort of Children with Cerebral Palsy

Kraus

Brunner

Rutz

2019

BJSTR

View full text Add to dashboard Cite

Background:Children with higher GMFCS level frequently suffer from progressive hip displacement. A common consequence is pain affecting the ability to sit, compromising care and thereby, impairing quality of life. While other treatments often fail, bony reconstructive surgery is able to sufficiently ease pain and restore the range of motion.Our study presents our experience with these bony procedures in our youngest patients. Methods: 76 procedures (41 hip reconstructions, 35 femoral osteotomies) in 39 patients aged 2 to 8 years (median 5) were studied. Surgical procedure duration and blood loss were recorded. Complication rates of the immediate postoperative course as well as the radiological outcomes of this cohort in the short-term 4 to 13 months postoperatively (median 9) are reported. Results:The overall operation time per hip (median 100min) and blood loss per procedure (median 10.4ml/kgBW) was satisfactory, however the complication rate was in total 70% including mild and moderate complications (grades I-III) in 66% (n=27) and severe complications (grades IV and V) in 4% (n=2) of patients according to the modified Clavien-Dindo classification. Radiographs confirmed a favourable reconstruction of bony hip biomechanics especially in combined pelvic and femoral procedures. Conclusions:Reconstructive hip surgery in young CP patients is challenging not only in terms of the procedure but also concerning management in the peri-and postoperative course. Management in an interdisciplinary setting including initial postoperative ICU admission, a low threshold for blood transfusions and an experienced surgeon is required.

show abstract

Classifying Adverse Events Following Lower Limb Orthopaedic Surgery in Children With Cerebral Palsy: Reliability of the Modified Clavien-Dindo System

Abstract: Supplemental Digital Content is available in the text.

Cited by 17 publications

References 26 publications

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series

Split Tibialis Anterior Tendon Transfer to The Peroneus Brevis or Tertius for the Treatment of Varus Foot Deformities in Children with Static Encephalopathy: A retrospective case series

Epidural Analgesia Versus Lumbar Plexus Blockade After Hip Reconstruction Surgery in Children With Cerebral Palsy and Intrathecal Baclofen Pumps: A Comparison of Safety and Efficacy

Risk Profile of Bony Intervention for Hip Displacement in our Youngest Cohort of Children with Cerebral Palsy

Contact Info

Product

Resources

About