A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: The hip joint tends to be highly affected in patients with Cerebral Palsy (CP).
Subluxation, problems with ambulation, posture, perineal hygiene, and pain can result. Severe
cases often require corrective surgery of the affected dysplastic hip(s). This often is
accomplished with varus derotational osteotomy (VDRO), femoral osteotomy, pelvic
osteotomy, tendon releases/lengthening, or a combination of any of these procedures. These
reconstructive hip surgeries can result in marked blood loss. Due to the highly vascularized
nature of bone, surgery can result in marked blood loss. This increases the transfusion burden
on the patient and increases exposure to blood products and the associated risks therein. By
identifying the risk factors that contribute to intraoperative and postoperative blood loss,
targeted strategies may be developed to reduce this risk to the patient.
Aims: The purpose of this study is to provide descriptive analysis of the pediatric CP population
undergoing corrective hip surgery. We will attempt to identify various risk factors that may
predispose patients to significant blood loss during reconstructive hip surgery. This study will be
the largest study analyzing blood management therapy with the VDRO procedure.
Methods: This is a retrospective chart review of consecutive CP patients who have undergone
reconstructive hip surgery at a single institution from 2000 to 2012. Demographic data to be
analyzed includes patient age, gender, race/ethnicity, height, weight, BMI, and medical
comorbidities. Also, type of procedure performed, bilateral vs unilateral reconstruction, specific
diagnosis, preoperative hemoglobin and hematocrit (H and H), pre‐transfusion H and H,
estimated blood loss (EBL), total operative time, cell saver volume, units transfused,
complications, quantity of postoperative transfusion, and post‐transfusion H and H was
recorded. Data was compared using the Chi‐squared method, or non‐parametric analog, to
assess the likelihood of the need for postop transfusions as an initial univariate analyses.
Results: 87 patients were included in the study. There was no significant relationship between
the use of autologous blood and age, gender, weight, height, or BMI. Patients who received
autologous blood also had a higher EBL (p=0.029) and were more likely to need allogenic
transfusion (p=0.023). Concomitant DEGA procedure carried a 2.25 times relative risk of
needing blood transfusion (p<0.001, 95% CI 1.402‐3.611). Bilateral VDRO was 1.64 times more
likely to need a transfusion, however this was not quite statistically significant (p=0.052, 95% CI
0.972‐2.756)
Conclusion: Varus derotational osteotomy for the correction of neuromuscular hip dysplasia
can be associated with excessive blood loss, especially in the CP patient population. The use of autologous vs allogenic blood products carries various risks and benefits. This paper has
identified that the need of concomitant DEGA osteotomy is correlated with increased blood
loss. Also, the use of autologous blood product is correlated with increased blood loss.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/603585 |
| Date | 23 March 2016 |
| Creators | Arthur, Jaymeson |
| Contributors | The University of Arizona College of Medicine - Phoenix |
| Publisher | The University of Arizona. |
| Source Sets | University of Arizona |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
| Rights | Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. |
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