Outpatient hospital utilization after single event multi-level surgery in children with cerebral palsy

Issue title: Cerebral Palsy

Guest editors: Rachel Byrne, Deborah Gaebler-Spira, Michael Green and Heakyung Kim

Article type: Research Article

Authors: Greve, Kelly R.^{a; b; *} | Bailes, Amy F.^{a; b} | Zhang, Nanhua^{c; d} | Long, Jason^{e; f} | Aronow, Bruce^{d; g} | Mitelpunkt, Alexis^{g; h; i}

Affiliations: [a] Motion Analysis Lab, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [b] Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA | [c] Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [d] College of Medicine, University of Cincinnati, Cincinnati, OH, USA | [e] Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [f] Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [g] Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA | [h] Department of Rehabilitation, Pediatric Rehabilitation, Dana-Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv, Israel | [i] Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence: [*] Corresponding author: Kelly R. Greve, PT, DPT, PhD, PCS, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229, USA. Tel.: +1 513 6363605; Fax: +1 513 6365742; E-mail: Kelly.Greve@cchmc.org.

Abstract: PURPOSE:This study aimed to examine outpatient hospital utilization (number of specialties seen and number of visits to each specialty) in the year after single event multi-level surgery (SEMLS) in children with cerebral palsy (CP), and to determine if utilization differs across the medical center in the year after compared to the year before SEMLS. METHODS:This retrospective cross-sectional study used electronic medical record data of outpatient hospital utilization in children with CP who underwent SEMLS. RESULTS:Thirty children with CP (Gross Motor Function Classification System Levels I–V, mean age of 9.9 years) were included. In the year after surgery, a significant difference (p = 0.001) was found for the number of specialties seen, with non-ambulatory children seeing more specialties than ambulatory children. No statistically significant difference was found between the number of outpatient visits to each specialty in the year after SEMLS. Compared to the year before SEMLS, fewer therapy visits occurred in the year after SEMLS (p < 0.001) but significantly more visits to orthopaedics (p = 0.001) and radiology (p = 0.001). CONCLUSION:Children with CP had fewer therapy visits but more orthopaedic and radiology visits the year after SEMLS. Nearly half of the children were non-ambulatory. Examination of care needs in children with CP undergoing SEMLS is justified with consideration of ambulatory status, surgical burden, and post-operative immobilization.

Keywords: Cerebral palsy, single event multi-level surgery, surgical burden

DOI: 10.3233/PRM-220051

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 139-148, 2023