Trends in Reconstructive Hip Surgery for Cerebral Palsy in U.S. Community Hospitals Before and After Publication of National Hip Surveillance Guidelines

Hip surveillance guidelines have been introduced by the Australian (AusACPDM, 2008) and American Academy for Cerebral Palsy and Developmental Medicine (AACPDM, 2016) to screen for hip displacement in children with cerebral palsy (CP). Whether these guidelines are associated with changes in surgical management remains unknown. This study compares trends in hip osteotomy rates among children with cerebral palsy in the United States using a national database before and after the publication of national hip surveillance guidelines. ICD-9-CM and ICD-10-CM codes were used to identify hospital admissions for hip osteotomies in children < 20 years old with CP from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) from 1997-2019. Cases without an admission month were excluded. National estimates of CP-related hospital cases, osteotomy (acetabular, proximal femoral) rates, and hip dislocations were calculated using weighted variables provided by HCUP. The average monthly osteotomy rates were compared using one-way ANOVA for the periods before and after guideline establishments. Baseline patient characteristics were also analyzed by either chi-squared tests or one-way ANOVA. From 1997-2019, 318,367 weighted CP admissions were recorded, demonstrating a 44% increase in the annual incidence of CP hospitalizations. Baseline patient characteristics between January 1997- December 2006 (preAusACPDM), January 2009-September 2016 (post-AusACPDM, pre-AACPDM), and October 2016-December 2019 (post-AACPDM) shows the mean age and length-of-stay (LOS) were higher (p < 0.01) from post-AACPDM compared to the two prior time periods. The average monthly osteotomy rate was highest in the pre-AusACPDM period and decreased significantly beginning in the post-AusACPDM period, reaching its lowest level in the post-AACPDM period (p < 0.01). Reconstructive hip surgery rates declined among children with cerebral palsy treated in U.S. community hospitals represented in the KID database, temporally coinciding with publication of national hip surveillance guidelines. These findings demonstrate an association rather than a causal relationship and may reflect variation in guideline adoption, shifts in care to tertiary referral centers, or evolving surgical practices. • Hip surveillance guidelines are screening tools for children with cerebral palsy. • Early detection of hip subluxation is crucial for timely orthopedic interventions. • Children with cerebral palsy are hospitalized at older ages with longer stay. • Barriers may exist that prevent adherence to hip surveillance guidelines. • Formal guideline implementation may be necessary to improve outcomes.