J Korean Med Sci.  2015 Apr;30(4):489-494. 10.3346/jkms.2015.30.4.489.

Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

• Lee SY
• Sohn HM
• Chung CY
• Do SH
• Lee KM
• Kwon SS
• Sung KH
• Lee SH
• Park MS

• KMID: 2164459
• DOI: http://doi.org/10.3346/jkms.2015.30.4.489

Abstract

Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications.

Keyword

Cerebral Palsy; Perioperative Complication; Single Event Multilevel Surgery; GMFCS Level; ASA Class

MeSH Terms

Adolescent
Adult
Cerebral Palsy/*complications
Child
Child, Preschool
Female
Humans
Intraoperative Complications/*etiology
Lower Extremity/*surgery
Male
Middle Aged
Orthopedic Procedures/*adverse effects
Postoperative Complications/*etiology

Figure

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  Fig. 1 Patient distribution according to CL classification and ASA classification levels and overall incidence of intraoperative hypothermia, hypotension, and bradycardia (Number of patients [%]; CL, Cormack and Lehane; ASA class, American Society of Anesthesiologist Physical Status Classification System).

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