Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2022; 13(4): 373-380
Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.373
Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease: A database study
Achraf Jardaly, Timothy W Torrez, Gerald McGwin, Shawn R Gilbert
Achraf Jardaly, Department of Orthopaedics, Hughston Foundation/Hughston Clinic, Columbus, GA 31909, United States
Timothy W Torrez, Department of Orthopedics, University of Alabama, Birmingham, AL 35205, United States
Gerald McGwin, Department of Epidemiology, Center of Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL 35205, United States
Shawn R Gilbert, Department of Pediatric Orthopaedics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
Author contributions: Jardaly A contributed to the manuscript preparation, data collection, revisions; Torrez TW contributed to the manuscript preparation, data collection, revisions; McGwin G contributed to the data analysis and statistics; Gilbert SR contributed to the manuscript preparation and was the principal investigator.
Institutional review board statement: This study was institutional review board exempt.
Informed consent statement: Informed consent was waived as per the University of Alabama at Birmingham’s IRB guidelines.
Conflict-of-interest statement: The authors do not endorse any conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at achraf.jardaly@lau.edu.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shawn R Gilbert, MD, Surgeon, Department of Pediatric Orthopaedics, University of Alabama at Birmingham, ACC Suite 316, Children’s Hospital, 1600 7th Avenue South, Birmingham, AL 35233, United States. srgilbert@uabmc.edu
Received: July 27, 2021
Peer-review started: August 2, 2021
First decision: December 27, 2021
Revised: January 10, 2022
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 18, 2022
Abstract
BACKGROUND

Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting. Two recent examples include slipped capital femoral epiphysis (SCFE) and Blount’s disease. Surgical indications are well-studied for each pathology, but to our knowledge, there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition. We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.

AIM

To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.

METHODS

The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics, rates of complications, and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.

RESULTS

Total 1788 SCFE database entries were included, 30% were performed in an outpatient setting. In situ pinning was used in 98.5% of outpatient surgeries and 87.8% of inpatient surgeries (P < 0.0001). Inpatients had a greater percent of total complications than outpatients 2.57% and 1.65% respectively. Regarding Blount’s disease, outpatient surgeries constituted 41.2% of the 189 procedures included in our study. The majority of inpatients were treated with a tibial osteotomy, while the majority of outpatients had a physeal arrest (P < 0.0001). Complications were encountered in 7.4% of patients, with superficial surgical site infections and wound dehiscence being the most common. 1.6% of patients had a readmission. No differences in complication and readmission risks were found between inpatients and outpatients.

CONCLUSION

The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting. This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions. Osteotomies are more commonly performed in an inpatient setting where monitoring is available.

Keywords: Outpatient surgery, Early discharge, Slipped capital femoral epiphysis, Blount’s disease

Core Tip: In our retrospective analysis of common complications of both slipped capital femoral epiphysis and Blount’s disease using National Surgical Quality Improvement Program database. We showed equivocally that treating both these conditions as an outpatient was safe and effective.