The Impact of Verbal Status on Postoperative Outcomes Following Proximal Femur Varus Derotational Osteotomy in Children With Cerebral Palsy.

Abstract

Background: In addition to physical disabilities, children with cerebral palsy (CP) often have concomitant nonphysical disabilities and associated medical comorbidities. Verbal disabilities are common and can affect both independence and communication, particularly in hospital settings, potentially impacting surgical outcomes. This study evaluates how verbal status affects postoperative outcomes of proximal femur varus derotational osteotomy (VDRO).

Methods: A retrospective review of pediatric patients with CP who underwent VDRO for hip subluxation/dislocation between 2017 and 2021 at a single tertiary care institution was completed. Demographic data, including age, weight, height, BMI, sex, race/ethnicity, insurance status, Gross Motor Function Classification System (GMFCS), and verbal status was recorded. Outcome variables included acute complications occurring within 90 days after surgery and delayed complications occurring >90 days postoperatively. Acute complications included emergency department (ED) visits, readmissions, reoperations, deep surgical-site infections, and medical complications such as pneumonia, atelectasis, and gastrointestinal bleeds. Delayed complications included delayed union, re-subluxation/dislocation, nonunion, painful hardware, and superficial surgical-site infection. Descriptive statistics, 2-sample t tests, and multiple regression analyses were performed.

Results: Seventy-two patients were included for analysis, 26 (35.1%) of whom were verbal and 46 (63.9%) nonverbal. In unadjusted analysis, nonverbal status was associated with higher rates of acute complications [OR=14.29, 95% CI (3.26, 64.83), P <0.0001] and increased ED visits [OR=7.86, 95% CI (1.17, 87.78), P =0.05] compared with verbal patients. However, after adjusting for GMFCS, these associations were no longer statistically significant. Conversely, after controlling for GMFCS, nonverbal patients were at significantly lower risk of experiencing delayed complications [OR=0.07, 95% CI (0.01, 0.36), P =0.0010] and painful hardware [OR=0.07, 95% CI (0.01, 0.33), P =0.0010] compared with verbal patients.

Conclusion: Verbal status plays a significant role in postoperative outcomes for children with CP undergoing VDRO. Nonverbal patients are at higher risk for acute complications, while verbal patients are more likely to present for delayed complications. These findings reinforce the need for enhanced communication strategies and vigilant postoperative monitoring in this particularly vulnerable population.

Level of evidence: Level IV.