Vineet M Desai, Thomas Coleman, John W Stelzer, Margaret Bowen, Jason B Anari, John M Flynn, Burt Yaszay, Paul Sponseller, Mark Abel, Patrick J Cahill
{"title":"有术后并发症的脑瘫性脊柱侧凸患者术后2年CPCHILD评分较差吗?","authors":"Vineet M Desai, Thomas Coleman, John W Stelzer, Margaret Bowen, Jason B Anari, John M Flynn, Burt Yaszay, Paul Sponseller, Mark Abel, Patrick J Cahill","doi":"10.1097/BPO.0000000000003010","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Surgical intervention for scoliosis in the cerebral palsy (CP) population is associated with high rates of postoperative complications. Research regarding whether complications after spinal fusion for CP scoliosis patients affect long-term health-related quality of life (HRQOL) remains limited. The goal of this study was to determine if CP scoliosis patients with major postoperative complications have worse HRQOL 2 years after surgery.</p><p><strong>Materials and methods: </strong>A retrospective analysis of a prospectively collected, multicenter registry was performed for all patients with nonambulatory CP treated with spinal fusion from 2008 to 2019 with at least 2 years of follow-up. HRQOL was measured through the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Complications included anything life-threatening, extended hospitalization, spinal cord/nerve injury, or reoperation. Complications were also classified as \"existing\" or \"resolved\" based on the 2-year postoperative visit. Patients with existing or unresolved complications at the 2-year postoperative visit were excluded.</p><p><strong>Results: </strong>There were 298 CP patients operated on during the study period (51% male, mean age: 14.3±3 y). Within this cohort, 208 patients (70.0%) were identified as GMFCS V. 76 patients (26%) experienced a postoperative complication. Seventy-one patients (93%) had a complication that resolved by 2 years postoperatively. Five patients (7%) had complications that did not resolve and required ongoing treatment. The most common complication was infection (13%). There was no difference in CPCHILD total, as well as domain HRQOL scores at 2 years postoperatively between patients without complications and patients with resolved complications ( P >0.05). Similarly, there was no difference in mean improvements in CPCHILD total and domain scores at 2 years postoperatively between the no complication and resolved complication cohorts ( P >0.05).</p><p><strong>Conclusion: </strong>Patients with CP scoliosis who experience postoperative complications that resolved by 2 years postoperatively have no significant difference in HRQOL in comparison to those without postoperative complications as measured through the CPCHILD questionnaire. Patients and surgeons can be reassured that despite a high complication rate in CP scoliosis surgery, the initial expectations of improved HRQOL are not diminished as long as the complication is appropriately identified and managed.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e775-e781"},"PeriodicalIF":1.5000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Do Cerebral Palsy Scoliosis Patients With Postoperative Complications Have Worse CPCHILD Scores 2 Years After Surgery?\",\"authors\":\"Vineet M Desai, Thomas Coleman, John W Stelzer, Margaret Bowen, Jason B Anari, John M Flynn, Burt Yaszay, Paul Sponseller, Mark Abel, Patrick J Cahill\",\"doi\":\"10.1097/BPO.0000000000003010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Surgical intervention for scoliosis in the cerebral palsy (CP) population is associated with high rates of postoperative complications. Research regarding whether complications after spinal fusion for CP scoliosis patients affect long-term health-related quality of life (HRQOL) remains limited. The goal of this study was to determine if CP scoliosis patients with major postoperative complications have worse HRQOL 2 years after surgery.</p><p><strong>Materials and methods: </strong>A retrospective analysis of a prospectively collected, multicenter registry was performed for all patients with nonambulatory CP treated with spinal fusion from 2008 to 2019 with at least 2 years of follow-up. HRQOL was measured through the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Complications included anything life-threatening, extended hospitalization, spinal cord/nerve injury, or reoperation. Complications were also classified as \\\"existing\\\" or \\\"resolved\\\" based on the 2-year postoperative visit. Patients with existing or unresolved complications at the 2-year postoperative visit were excluded.</p><p><strong>Results: </strong>There were 298 CP patients operated on during the study period (51% male, mean age: 14.3±3 y). Within this cohort, 208 patients (70.0%) were identified as GMFCS V. 76 patients (26%) experienced a postoperative complication. Seventy-one patients (93%) had a complication that resolved by 2 years postoperatively. Five patients (7%) had complications that did not resolve and required ongoing treatment. The most common complication was infection (13%). There was no difference in CPCHILD total, as well as domain HRQOL scores at 2 years postoperatively between patients without complications and patients with resolved complications ( P >0.05). Similarly, there was no difference in mean improvements in CPCHILD total and domain scores at 2 years postoperatively between the no complication and resolved complication cohorts ( P >0.05).</p><p><strong>Conclusion: </strong>Patients with CP scoliosis who experience postoperative complications that resolved by 2 years postoperatively have no significant difference in HRQOL in comparison to those without postoperative complications as measured through the CPCHILD questionnaire. Patients and surgeons can be reassured that despite a high complication rate in CP scoliosis surgery, the initial expectations of improved HRQOL are not diminished as long as the complication is appropriately identified and managed.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":16945,\"journal\":{\"name\":\"Journal of Pediatric Orthopaedics\",\"volume\":\" \",\"pages\":\"e775-e781\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Orthopaedics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BPO.0000000000003010\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/5/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Orthopaedics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BPO.0000000000003010","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Do Cerebral Palsy Scoliosis Patients With Postoperative Complications Have Worse CPCHILD Scores 2 Years After Surgery?
Background: Surgical intervention for scoliosis in the cerebral palsy (CP) population is associated with high rates of postoperative complications. Research regarding whether complications after spinal fusion for CP scoliosis patients affect long-term health-related quality of life (HRQOL) remains limited. The goal of this study was to determine if CP scoliosis patients with major postoperative complications have worse HRQOL 2 years after surgery.
Materials and methods: A retrospective analysis of a prospectively collected, multicenter registry was performed for all patients with nonambulatory CP treated with spinal fusion from 2008 to 2019 with at least 2 years of follow-up. HRQOL was measured through the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire. Complications included anything life-threatening, extended hospitalization, spinal cord/nerve injury, or reoperation. Complications were also classified as "existing" or "resolved" based on the 2-year postoperative visit. Patients with existing or unresolved complications at the 2-year postoperative visit were excluded.
Results: There were 298 CP patients operated on during the study period (51% male, mean age: 14.3±3 y). Within this cohort, 208 patients (70.0%) were identified as GMFCS V. 76 patients (26%) experienced a postoperative complication. Seventy-one patients (93%) had a complication that resolved by 2 years postoperatively. Five patients (7%) had complications that did not resolve and required ongoing treatment. The most common complication was infection (13%). There was no difference in CPCHILD total, as well as domain HRQOL scores at 2 years postoperatively between patients without complications and patients with resolved complications ( P >0.05). Similarly, there was no difference in mean improvements in CPCHILD total and domain scores at 2 years postoperatively between the no complication and resolved complication cohorts ( P >0.05).
Conclusion: Patients with CP scoliosis who experience postoperative complications that resolved by 2 years postoperatively have no significant difference in HRQOL in comparison to those without postoperative complications as measured through the CPCHILD questionnaire. Patients and surgeons can be reassured that despite a high complication rate in CP scoliosis surgery, the initial expectations of improved HRQOL are not diminished as long as the complication is appropriately identified and managed.
期刊介绍:
Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.