The Effect of Body Mass Index on Postoperative Morbidity After Orthopaedic Surgery in Children With Cerebral Palsy

Minhas, Shobhit V.; Chow, Ian; Otsuka, Norman Y.

doi:10.1097/bpo.0000000000000475

Cited by 14 publications

(23 citation statements)

References 28 publications

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“…NSQIP-P has been used to describe adverse events following common pediatric orthopedic procedures in order to identify procedures and patient characteristics associated with an increased risk of postoperative complications [26]. Other studies have considered outcomes after specific orthopedic procedures [27][28][29], most frequently involving the spine [30][31][32][33], as well as outcomes in orthopedic patients with specific risk factors such as obesity, congenital heart disease, or cerebral palsy [34][35][36]. To our knowledge, NSQIP-P has not been used to characterize outcomes after pediatric orthopedic oncology procedures.…”

Section: Introductionmentioning

confidence: 99%

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Gallaway

Ahn

Callan

2020

Sarcoma

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Background. Pediatric bone and soft tissue sarcomas are rare; therefore, national registries are essential tools for orthopedic oncology research. Past studies provide excellent data on long-term prognosis and survival trends but fail to examine treatment-specific morbidity. The aim of this study is to use a national registry to describe patient demographics, comorbidities, and adverse events in the first thirty days following surgical management of pediatric bone and soft tissue sarcomas. Methods. A retrospective review of patients in the American College of Surgeons National Surgical Quality Improvement Program—Pediatrics database (NSQIP-P) was performed. The cohort was partitioned by tumor origin (bone versus soft tissue) and tumor location (axial versus appendicular). Results. One-hundred ninety-two patients were identified. Bone sarcomas were more common (71.9%) and predominately appendicular (62.3%), while soft tissue sarcomas were predominately axial (77.8%). The overall complication rate was 8.9%. The most frequent etiologies were wound dehiscence (3.6%) and infectious complications such as surgical site infections (2.6%), pneumonia (1.6%), urinary tract infections (1.6%), and C. diff colitis (1.0%). Twenty-four percent of patients experienced bleeding requiring transfusion. The unplanned readmission rate was 12.5% (3.6% related to principle procedure), and the unplanned reoperation rate was 4.7% (4.2% related to principle procedure). The mortality rate was 1.0%. Neoadjuvant chemotherapy was associated with higher rates of wound dehiscence and infectious complications. There were no differences in adverse events with respect to tumor origin or location. Conclusion. Approximately 1 in 11 pediatric patients will experience a complication in the first thirty days following surgery. However, perioperative mortality remains low. This study represents the first comprehensive review of pediatric bone and soft tissue sarcoma surgery in the NSQIP-P database. As the case volume of NSQIP-P continues to grow, NSQIP-P has the potential to become a powerful tool for pediatric orthopedic oncology research.

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Section: Introductionmentioning

confidence: 99%

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Gallaway

Ahn

Callan

2020

Sarcoma

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“…In addition, Kato et al investigated cervical spine in patients with athetoid CP who underwent posterior decompression surgery ( n = 31) and multivariate analysis showed that pedicle sclerosis associated with a higher risk of breach of cervical pedicle screws ( 71 ). Further, Minhas et al evaluated the effect of body mass index class on complications after orthopedic surgery in children with CP ( n = 1,746) and multivariate logistic regression analysis revealed that underweight status was the risk factor for complications in osteotomies and spine surgery ( 76 ). The risk factors identified by these studies are helpful to avoid the surgical complications and improve surgical treatments in CP.…”

Section: Multivariate Analysis In Cp Outcome Evaluationmentioning

confidence: 99%

“…Taken together, since there is no cure for CP yet, and the death rate of CP is high (~8%), there is much to do to improve the outcomes of CP, and multivariate analytic approaches may play a bigger role in meeting such clinical demands. Surgical outcome predictors and risk factors for complications in CP surgical treatments have been identified by a number of multivariate outcome studies ( 63 , 64 , 67 , 69 , 71 , 73 , 76 ), which are useful not only for outcome evaluation and prediction but also for avoiding complications and improving surgical treatments in CP. However, there are few outcome studies for medications and supportive treatments (such as physical therapy) in CP using multivariate analysis.…”

Section: Multivariate Analysis In Cp Outcome Evaluationmentioning

confidence: 99%

Multivariate Analysis and Machine Learning in Cerebral Palsy Research

Zhang

2017

Front. Neurol.

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Cerebral palsy (CP), a common pediatric movement disorder, causes the most severe physical disability in children. Early diagnosis in high-risk infants is critical for early intervention and possible early recovery. In recent years, multivariate analytic and machine learning (ML) approaches have been increasingly used in CP research. This paper aims to identify such multivariate studies and provide an overview of this relatively young field. Studies reviewed in this paper have demonstrated that multivariate analytic methods are useful in identification of risk factors, detection of CP, movement assessment for CP prediction, and outcome assessment, and ML approaches have made it possible to automatically identify movement impairments in high-risk infants. In addition, outcome predictors for surgical treatments have been identified by multivariate outcome studies. To make the multivariate and ML approaches useful in clinical settings, further research with large samples is needed to verify and improve these multivariate methods in risk factor identification, CP detection, movement assessment, and outcome evaluation or prediction. As multivariate analysis, ML and data processing technologies advance in the era of Big Data of this century, it is expected that multivariate analysis and ML will play a bigger role in improving the diagnosis and treatment of CP to reduce mortality and morbidity rates, and enhance patient care for children with CP.

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“…This population often has such a high level of spasticity that the tone is essentially burning all the calories they can ingest, so the patient very often is undernourished, which is known to increase risk. 4 Lam et al did acknowledge that BMI for all patients, surgical technique, and preoperative preparation could not be considered for this study as they were not available in the NSQIP-P database. As these and other data points are known to contribute to complication risk, expanding the database to include these variables may assist in improving protocols for preoperative preparation.…”

mentioning

confidence: 99%

“…In addition, the BFMF describes functional capacity and may under-report difficulties in manual skills in the unilateral or less severe presentations seen in this cohort. This is compared to an alternative measure, the Manual Ability Classification System, 4 which also incorporates environmental and personal factors affecting manual ability as defined in the ICF. 3 The Stroke in Childhood guideline includes recommendations for broad multidisciplinary assessment at regular intervals to guide rehabilitation provision and monitor progress and outcome.…”

mentioning

confidence: 99%

Balancing the benefits of intrathecal baclofen pump surgery with potential postoperative complications

Buxton

2018

Develop Med Child Neuro

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The Effect of Body Mass Index on Postoperative Morbidity After Orthopaedic Surgery in Children With Cerebral Palsy

Abstract: Level III-Prognostic.

Cited by 14 publications

References 28 publications

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Thirty-Day Outcomes following Pediatric Bone and Soft Tissue Sarcoma Surgery: A NSQIP Pediatrics Analysis

Multivariate Analysis and Machine Learning in Cerebral Palsy Research

Balancing the benefits of intrathecal baclofen pump surgery with potential postoperative complications

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