Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

Abstract

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

Mode of Anesthesia and Bladder Management Following Orthopaedic Surgery in Children With Cerebral Palsy: A System Level Analysis

“…POUR, defined as inability to void within 8 hours postoperatively, has been reported in up to 70% in children with CP receiving epidural anesthesia, compared with 6% in controls. 1,7 As lower urinary tract dysfunction can subsist silently in children with CP and go undetected while increasing in severity, the likelihood of complications increases with each perioperative exposure. 2 The purpose of this study is to explore the influence of epidural anesthesia on postoperative bladder retention in children with CP undergoing hip and/or lower extremity orthopaedic surgery within a pediatric orthopaedic health care system.…”

“…Children with cerebral palsy (CP) often have reduced overall health which, makes them vulnerable to perioperative complications from anesthesia and surgical intervention. Risk factors for major complications in the postoperative period are associated with Gross Motor Function Classification System (GMFCS) levels, with children classified as GMFCS Level IV and V having a significantly higher rate of complications than those classified as GMFCS Levels I to III 1. In children with medical complexity, bladder dysfunction was the only chronic condition found to be significantly associated with higher hospital cost, longer length of stay (LOS), and greater likelihood of hospital readmission 2…”

Orthopedic surgery in cerebral palsy: Instructional course lecture

“… 108 2.3% patients had major complications, and 4.0% patients had minor complications postoperatively. 108 Other perioperative complications include fat embolism, cardiorespiratory and gastrointestinal complications, wound infection and wound bleeding. Complications of OS can be classified into under correction (e.g., inability to achieve a horizontal pelvis after posterior instrumentation and fusion for thoracolumbar scoliosis), overcorrection (e.g., a calcaneovalgus deformity after tibialis anterior transfer for equinovarus deformity of foot) or recurrence following a successfully treated deformity.…”

“…Intraoperative and major immediate postoperative complications were significantly higher in patients at GMFCS Levels IV and V, older age, hip reconstructive surgery, and history of pneumonia 108. 2.3% patients had major complications, and 4.0% patients had minor complications postoperatively 108. Other perioperative complications include fat embolism, cardiorespiratory and gastrointestinal complications, wound infection and wound bleeding.…”

Orthopedic treatment of the lower limbs in spastic paralysis

“…Single-event multilevel surgery (SEMLS) is considered the gold standard treatment for ambulatory CP patients with GMFCS levels I–III [35, 36]. It has been defined as a combination of two or more soft-tissue or bony operative procedures at two or more anatomical levels and addresses the correction of all fixed musculoskeletal pathology in one surgical procedure to improve both gait and gross motor function [37, 38]. The superiorities in SEMLS involve decreased need for repeated anesthetics and single stay in inpatient rehabilitation, as well as the prevention of secondary deformities from delay in sequential “birthday syndrome” [39].…”