Postoperative Complications After Hip Surgery in Patients With Cerebral Palsy: A Retrospective Matched Cohort Study.

BACKGROUND: Little is known about the postoperative complications experienced by patients with severe cerebral palsy (CP) (GMFCS IV-V) compared with otherwise healthy patients with hip pathology requiring surgery. The purpose of this study was to determine whether differences exist between these 2 groups with respect to the incidence, type, and severity of complications. In addition, we evaluated the risk factors for complications and the number and cost of additional visits, hospital admissions, and repeat surgeries due to complications. METHODS: Retrospective matched cohort study of 55 patients aged 3 to 25 years with severe CP and 55 non-CP patients with hip dysplasia who underwent hip osteotomies (2000 to 2012). Postoperative complications were evaluated using the adapted Clavien-Dindo classification system. Binary and ordinal logistic regressions were used to identify risk factors for complications. The number and cost of unplanned visits, admissions, and surgeries were calculated. RESULTS: CP patients experienced almost twice as many complications as the non-CP patients (P=0.004). All types of complications occurred in both groups except orthopaedic complications (P<0.001) were more frequent in the non-CP group. CP patients were 82% more likely to develop a complication compared with non-CP patients (relative risk=1.82; 95% confidence interval=1.21 to 2.76). The severity of complications was comparable with no significant differences in the relative distribution between the groups. There was a significant difference between groups for the number of unplanned clinic and emergency department visits (P≤0.001). The average cost for treating a complication was $1857.00 for CP and $1800.00 for non-CP (P=0.72). CONCLUSIONS: Although patients with severe CP requiring hip surgery have a 65% chance of experiencing at least 1 postoperative complication compared with 36% of non-CP patients, most of the complications were medical in the CP patients (n=46, 83%) as opposed to the non-CP patient who experienced predominantly orthopaedic complications (59%). When these complications occur the associated costs are greater for CP patients as a whole, but are relatively similar per patient. LEVEL OF EVIDENCE: Level III­Prognostic, case-control study.

Frozen section versus gross examination for bone marrow margin assessment during sarcoma resection.

BACKGROUND: Complete resection is critical for local control of primary bone sarcomas. Intraoperative consultation, including frozen section of bone marrow margins, frequently is used to aid in this goal. QUESTIONS/PURPOSES: We therefore sought to determine (1) how often intraoperative frozen section of a bone marrow margin correlates with inspection of the gross split specimen and, in cases of a discrepancy, what clinical decision is made; and (2) how well each of these assessments agrees with the final pathologic assessment of a marrow margin. METHODS: One hundred ninety-five bone marrow margins from 142 patients (74 males, 68 females; mean age, 12.8 years) with primary sarcomas who underwent resection and had frozen section(s) performed on a bone marrow margin were analyzed. Agreement between frozen section interpretation and inspection of the split gross specimen was analyzed in their application to determine adequacy of the bone marrow margin intraoperatively. RESULTS: In 179 margins, the frozen section agreed with the gross inspection decision (95.6% negative agreement, 38.5% positive agreement). Decisions regarding further surgical action in all 16 instances of disagreement were based on inspection of the split gross specimen, and the frozen section was disregarded. In 195 of 195 margins, intraoperative decisions were made based on gross specimen inspection. Full pathologic examination confirmed negative final bone marrow margins in all patients. CONCLUSIONS: Frozen section is commonly redundant or disregarded for intraoperative surgical decisions, and it may be omitted, saving operative time and cost. Examination of split gross specimens appears an adequate adjunct to clinicoradiographic assessment to achieve negative margins in the current era of modern imaging and surgical techniques. LEVEL OF EVIDENCE: Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Psychosocial outcomes for children with nonalcoholic fatty liver disease over time and compared with obese controls.

OBJECTIVES: Children with nonalcoholic fatty liver disease (NAFLD) experience compromised quality of life (QOL) akin to those with other chronic disease. Our objectives were to examine the association between NAFLD and QOL as well as other psychosocial outcomes, to compare psychosocial outcomes to obese children without known NAFLD, and to determine whether present standard care for NAFLD results in weight loss and improvement in psychosocial outcomes longitudinally. METHODS: Children with NAFLD between 8 and 18 years and obese control children without known NAFLD were consented to complete a brief psychosocial battery examining depression (Children's Depression Inventory), QOL (Pediatric Quality of Life Inventory; PedsQL), and effect of weight on self-esteem (Body-Esteem Scale for Adolescents and Adults) at baseline; and additionally for the NAFLD group after at least 6 months. RESULTS: A total of 48 children with NAFLD and 40 obese control children were enrolled. The PedsQL scores were not significantly different but the CDI total score and subscales of negative mood, ineffectiveness, and negative self-esteem as well as all of the 3 subscales of BESAA, appearance, attribution, and weight were worse in the NAFLD group compared with obese controls. The PedsQL scores also did not change after standard care in the 33 patients with NAFLD who completed the follow-up evaluations, but the CDI score differed between those whose body mass index improved or not. CONCLUSIONS: Children with NAFLD have higher levels of depression than obese controls. Outcomes did not improve with standard care. Larger longitudinal studies and appropriate interventions are required in this area.