Preoperative Medical Evaluation and Optimisation of Children and Adolescents With Cerebral Palsy ( GMFCS IV and V) With Complex Medical Comorbidity Undergoing Lower Limb Orthopaedic Surgery: Results of a Combined Rehabilitation Orthopaedic Paediatric

AIM: To describe preoperative medical evaluation, optimisation and acute postoperative outcomes in children and adolescents with cerebral palsy (CP) undergoing lower limb orthopaedic surgery managed in a Combined Rehabilitation Orthopaedic Paediatric Service (CROPS). METHODS: A retrospective medical record review of children and adolescents with CP managed in CROPS between 1 January 2019 and 1 June 2024. INCLUSION CRITERIA: patients were between 0 and 19 years of age, had CP (Gross Motor Function Classification System IV or V) and had lower limb orthopaedic surgery. RESULTS: Fifty-three patients were included in the analysis. Median age at preoperative medical review was 8 years 9 months (range 2 years 2 months to 18 years 3 months, IQR 6 years 5 months). Twenty patients needed seizure management (n = 20/42, 37.7%), eighteen needed feeding input (n = 18/53, 34.0%), fourteen required respiratory optimisation (n = 14/53, 26.4%) and thirteen needed nutritional supplementation (n = 13/53, 24.5%) prior to surgery. There was only one intraoperative complication. Postoperatively, thirteen patients (n = 13/53, 24.5%) required antibiotics for respiratory infections, nine (n = 9/53, 17.0%) had feed intolerance, five (n = 53, 9.4%) developed pressure injuries and one (n = 1/53, 1.9%) developed a urinary tract infection. CONCLUSIONS: There were minimal intraoperative complications, most occurring postoperatively, supporting the need for preoperative medical evaluation and shared care in the postoperative period.