Perioperative Health Interventions in Children With Chronic Neuromuscular Conditions Undergoing Major Musculoskeletal Surgery: A Scoping Review

Mirna Giordano; David Casavant; Juan Carlos Flores Cano; Gina Rempel; Anna Dorste; Robert J Graham; Sara K Quates; Mohan V Belthur; Lucia C Bastianelli; Taylor B Sewell; Jason Zamkoff; Sangeeta Mauskar; Juliana Mariani; Margaret J Trost; Blair Simpson; Isabel Stringfellow; Jay G Berry

doi:10.1542/hpeds.2021-006187

Perioperative Health Interventions in Children With Chronic Neuromuscular Conditions Undergoing Major Musculoskeletal Surgery: A Scoping Review

Hosp Pediatr. 2024 May 10:e2021006187. doi: 10.1542/hpeds.2021-006187. Online ahead of print.

Authors

Mirna Giordano¹, David Casavant², Juan Carlos Flores Cano³, Gina Rempel⁴, Anna Dorste⁵, Robert J Graham², Sara K Quates⁶, Mohan V Belthur⁷, Lucia C Bastianelli⁸, Taylor B Sewell¹, Jason Zamkoff⁹, Sangeeta Mauskar¹⁰, Juliana Mariani¹¹, Margaret J Trost¹², Blair Simpson^{13

14}, Isabel Stringfellow^{10

8}, Jay G Berry^{10

8}

Affiliations

¹ Department of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University, New York, New York.
² Divisions of Critical Care Medicine.
³ Division of Pediatrics, Pontificia Universidad Catolica de Chile, Hospital Dr. Sotero del Rio, Santiago, Chile.
⁴ Nutrition Support and Complex Care, Department of Pediatrics and Children Health, University of Manitoba, Winnipeg, Canada.
⁵ Boston Children's Hospital Medical Library, Boston, Massachusetts.
⁶ Medical College of Wisconsin, Children's Wisconsin Hospital, Milwaukee, Wisconsin.
⁷ Division of Pediatrics, University of Arizona College of Medicine Phoenix, Phoenix, Arizona.
⁸ Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts.
⁹ Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, Colorado.
¹⁰ General Pediatrics.
¹¹ Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
¹² Keck School of Medicine of the University of Southern California, Los Angeles, California.
¹³ Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
¹⁴ Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.

PMID: 38726564
DOI: 10.1542/hpeds.2021-006187

Abstract

Background and objectives: Children with chronic neuromuscular conditions (CCNMC) have many coexisting conditions and often require musculoskeletal surgery for progressive neuromuscular scoliosis or hip dysplasia. Adequate perioperative optimization may decrease adverse perioperative outcomes. The purpose of this scoping review was to allow us to assess associations of perioperative health interventions (POHI) with perioperative outcomes in CCNMC.

Methods: Eligible articles included those published from January 1, 2000 through March 1, 2022 in which the authors evaluated the impact of POHI on perioperative outcomes in CCNMC undergoing major musculoskeletal surgery. Multiple databases, including PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature, Web of Science, the Cochrane Library, Google Scholar, and ClinicalTrials.gov, were searched by using controlled vocabulary terms and relevant natural language keywords. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to perform the review. A risk of bias assessment for included studies was performed by using the Risk of Bias in Non-randomized Studies of Interventions tool.

Results: A total of 7013 unique articles were initially identified, of which 6286 (89.6%) were excluded after abstract review. The remaining 727 articles' full texts were then reviewed for eligibility, resulting in the exclusion of 709 (97.5%) articles. Ultimately, 18 articles were retained for final analysis. The authors of these studies reported various impacts of POHI on perioperative outcomes, including postoperative complications, hospital length of stay, and hospitalization costs. Because of the heterogeneity of interventions and outcome measures, meta-analyses with pooled data were not feasible.

Conclusions: The findings reveal various impacts of POHI in CCNMC undergoing major musculoskeletal surgery. Multicenter prospective studies are needed to better address the overall impact of specific interventions on perioperative outcomes in CCNMC.