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Child/Adolescent Health

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Children with cerebral palsy have a greater risk of surgical complications and poor outcomes than other children

Children with cerebral palsy (CP), who undergo numerous surgeries, tend to suffer more surgical complications and poorer outcomes than children without CP. In 1997, 5,614 surgeries were performed in children with CP to manage the nutritional, gastrointestinal, or orthopedic complications of the disease. That year, the most common surgeries performed in children with CP were gastrostomy tube placements (1,743), soft tissue musculoskeletal procedures (1,393), anti-reflux surgery (1,062), spinal fusions with instrumentation (765), and bony hip surgeries (651). Together, these 5 procedures accounted for nearly 50,000 hospital days and over $150 million in hospital charges.

About one-third of children with CP are under-nourished and gastrostomy tubes and anti-reflux procedures are often indicated, with about 8 percent of CP children having one of these procedures in 1997. Nutritional deficiencies, coupled with recurrent bouts of aspiration and gastrointestinal motility disorders can increase the risk for post-operative complications in these children.

Musculoskeletal surgeries of the hips and extremities of children with CP were associated with low rates of complications and relatively brief hospitalizations. Only about 2 percent of children suffered from pneumonia or respiratory failure and even fewer developed urinary tract infections. Of the five surgical procedures studied, spine surgery resulted in the largest difference in hospital length of stay, charges, mortality, and complication rates between children with and without CP.

Death was an infrequent outcome during hospitalization for each of the surgeries studied. However, 4 of 765 children with CP (0.5 percent) who underwent spine surgeries died. These findings are the first to describe the national impact of surgery on the more than 100,000 U.S. children with CP based on analysis of the 1997 Healthcare Cost and Utilization Project Kids' Inpatient Database. The study was supported by the Agency for Healthcare Research and Quality (HS11826).

More details are in "A national perspective of surgery in children with cerebral palsy," by Nancy A. Murphy, M.D., Charles Hoff, Ph.D., Trisha Jorgensen, B.S., and others, in the July 2006 Pediatric Rehabilitation 9(3), pp. 293-300.

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