# The risk of complications in elective orthopedic surgeries in children and young adults with cerebral palsy: a population-based register study

## TL;DR

This study finds that children and young adults with cerebral palsy face higher risks of complications after orthopedic surgeries, especially those with severe motor impairments and skeletal procedures.

## Contribution

This is one of the few population-based studies quantifying postoperative complication risks in cerebral palsy patients undergoing elective orthopedic surgery.

## Key findings

- 13% of orthopedic surgeries in CP patients resulted in complications, with skeletal surgeries having a 1.6x higher risk than soft tissue surgeries.
- Individuals with GMFCS levels IV and V had significantly higher complication odds ratios (OR 7.0 and 7.9) compared to lower GMFCS levels.
- Infections accounted for 51% of all postoperative complications in this population.

## Abstract

Musculoskeletal deformities in cerebral palsy (CP) may be surgically treated, but population-based studies of postoperative complications after these surgeries are rare. The aim of our study was to assess the risk of complications following elective orthopedic surgery in children and young adults with CP.

We performed a register-based cohort study of 1,514 individuals born between 1990 and 2019 who underwent 2,983 orthopedic surgical events between January 1, 1997, and December 31, 2019. Data was obtained from the CP surveillance program CPUP, the Swedish National Patient Register, and the National Cause of Death Register. We used logistic regression to calculate odds ratios (OR) with 95% confidence intervals (CI) for postoperative complications within 90 days, in relation to the Gross Motor Function Classification System (GMFCS) level, anatomic level, and type of surgery (i.e., skeletal vs. soft tissue).

13% of all surgical events had at least 1 postoperative complication (6% in soft tissue surgeries, 17% in skeletal surgeries), and 51% of these were related to infection. The complication rate was higher in individuals with GMFCS levels IV and V than in the pooled GMFCS levels I–III. The highest ORs were found in GMFCS level V (7.0, CI 3.7–13.5) vs. GMFCS I and spinal surgery (7.9, CI 3.7–13.5) vs. foot/ankle surgery. The OR for skeletal surgery was 1.6 (CI 1.2–2.1) compared with soft tissue surgery.

13% of all surgical events had at least 1 postoperative complication. The risk of complications after elective orthopedic surgery was higher in children with higher GMFCS levels and in skeletal surgery compared with soft tissue surgery.