Association of Cerebral Palsy With Unanticipated Admission Following Pediatric Ambulatory Surgery.

Abstract

Background: Cerebral palsy, a neurologic disorder caused by damage to the developing brain, is a leading cause of childhood disability. Due to musculoskeletal, movement, and secondary impairments, children with cerebral palsy often require surgical care. With the growing cost of surgical care, many children with cerebral palsy are scheduled for surgery in an ambulatory setting. Whether cerebral palsy increases the risk of unanticipated admission (a critical quality indicator of care) following ambulatory surgery has not been characterized. Our objective was to determine the association of cerebral palsy with unanticipated admission following pediatric ambulatory surgery.

Methods: We used the Pediatric Health Information System (PHIS) database to evaluate a retrospective cohort of children (< 18 years) who underwent scheduled ambulatory operations between January 1, 2010 and December 31, 2022. The primary outcome was unanticipated admission. Using log-binomial regression models, we estimated the relative risk and 95% confidence intervals for unanticipated admission, comparing patients with and without cerebral palsy. To account for confounding variables, we performed a 1:1 propensity score matching without replacement.

Results: A total of 1 954 108 children underwent ambulatory surgeries during the study period. Of these, 4.1% required unanticipated admission. The overall incidence of unanticipated admission was significantly higher among children with cerebral palsy than in those without (9.8% vs. 4.0%; p < 0.001). This association remained significant after multivariable adjustment (relative risk: 1.73; 95% CI: 1.59-1.87, p < 0.001).

Conclusion: Although cerebral palsy is not a contraindication for ambulatory surgery in children, it is significantly associated with the risk of unanticipated hospital admissions. This underscores the need for careful preoperative clinical site of care selection in this vulnerable patient population.

Level of evidence: Level II.