Adding value in single-event multilevel surgery (SEMLS) for cerebral palsy patients with crouch gait: A retrospective study showing value added by a second surgeon

Abstract

Background: Single event multilevel surgery (SEMLS) is a common treatment for ambulatory children with cerebral palsy (CP) who have bony and soft-tissue abnormalities at multiple levels within the lower extremities. We introduced a second surgical team to enable simultaneous bilateral procedures and assessed the cost savings resulting from simultaneous bilateral SEMLS versus staged bilateral SEMLS. Methods: We retrospectively reviewed patients with spastic diplegia treated by simultaneous or staged bilateral SEMLS from January 1, 2010, to December 1, 2015. We evaluated procedures performed, surgical duration, estimated blood loss (EBL) and blood transfusions, length of inpatient and rehabilitation admission, complications, and associated costs (normalized to 2015 dollars). Results: Eighteen eligible patients were identified with no significant differences in age, gender, or total number of procedures. Introduction of simultaneous bilateral SEMLS reduced costs by an average of $161,267. In this group, total length of stay was less for inpatient and rehabilitation stay. EBL was similar between the two groups: 683 mL versus 532 mL (P value 0.24). Thirty-six percent of the patients in the simultaneous group required a transfusion versus 0% in the staged group. Complications (n=3) in the staged group included infection, failure of fixation, and additional procedure for femoral derotation. Complications (n=2) in the simultaneous group included failure of fixation and readmission for symptomatic anemia. Conclusions: While some may favor staging interventions, simultaneous bilateral SEMLS with two surgical teams is a safe and effective alternative to help improve ambulatory function in CP patients associated with significant cost savings. The risk of allogenic blood transfusion may be increased with simultaneous bilateral SEMLS. Level of Evidence: Level IV.