Single Event Multilevel Surgery (SEMLS) for Children With Cerebral Palsy (CP)-Does Adding a Second Surgeon Make a Difference?

Abstract

Background: Single-event multilevel surgery (SEMLS) has been accepted as the standard of care for the surgical treatment of children with cerebral palsy (CP). However, little has been studied on the effect of dual-attending surgeons in SEMLS. The aim of this study was to compare the effect of single versus dual-attending surgeons on resource utilization and postoperative outcomes in children with CP undergoing SEMLS.

Methods: A total of 70 patients with CP or CP-like conditions, who were <20 years old, and who underwent SEMLS at a single institution, were identified. Bivariate comparisons were conducted using Student's t tests, Mann-Whitney U tests, and chi-squared tests. Stratified analyses were conducted within patient characteristic subgroups to compare operative outcomes within groups. Multivariable regression analyses were used to assess differences across surgeon cohorts while controlling for potential confounding factors.

Results: Patients were stratified into single versus dual surgeon cohorts (n=40 vs. n=30, respectively). No significant differences were noted with respect to age, sex, race, BMI, GMFCS level, or ASA level between groups. A higher proportion of patients with a seizure history (67% vs. 38%; P=0.03) and revision procedures (33% vs. 3%, respectively; P=0.001) were found in the dual surgeon cohort. Bivariate analysis demonstrated that operative times in the dual surgeon cohort were significantly decreased in GMFCS level IV/V patients (269.6 ± 46.7 vs. 356 ± 103.4 min; P=0.002) and patients undergoing hip reconstruction procedures (270.6 ± 53.2 vs. 337.4 ± 85.8 min; P=0.007). A significant decrease in total blood loss (20% in hip reconstruction patients, P=0.036, 25% in GMFCS IV/V patients, P=0.049) and OR costs (16% in GMFCS level IV/V patients, P=0.008) was also observed. Moreover, multivariable analysis found that dual surgeon procedures had a 50-minute average reduction in operative time (P=0.005); no differences were noted in complication rates, unplanned clinic visits, or re-operation rates.

Conclusions: A 2-surgeon team for SEMLS can significantly decrease operative time, total blood loss, and OR costs-particularly for hip reconstruction and higher GMFCS level patients.

Level of evidence: Level III.