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

Author:

Giordano Mirna1,Casavant David2,Flores Cano Juan Carlos3,Rempel Gina4,Dorste Anna5,Graham Robert J.2,Quates Sara K.6,Belthur Mohan V.7,Bastianelli Lucia C.8,Sewell Taylor B.1,Zamkoff Jason9,Mauskar Sangeeta10,Mariani Juliana11,Trost Margaret J.12,Simpson Blair1314,Stringfellow Isabel108,Berry Jay G.108

Affiliation:

1. aDepartment of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University, New York, New York

2. bDivisions of Critical Care Medicine

3. cDivision of Pediatrics, Pontificia Universidad Catolica de Chile, Hospital Dr. Sotero del Rio, Santiago, Chile

4. dNutrition Support and Complex Care, Department of Pediatrics and Children Health, University of Manitoba, Winnipeg, Canada

5. eBoston Children’s Hospital Medical Library, Boston, Massachusetts

6. fMedical College of Wisconsin, Children’s Wisconsin Hospital, Milwaukee, Wisconsin

7. gDivision of Pediatrics, University of Arizona College of Medicine Phoenix, Phoenix, Arizona

8. hCerebral Palsy and Spasticity Center, Boston Children’s Hospital, Boston, Massachusetts

9. iDepartment of Pediatrics, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, Colorado

10. jGeneral Pediatrics

11. kMedical Critical Care, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts

12. lKeck School of Medicine of the University of Southern California, Los Angeles, California

13. mDivision of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

14. nDepartment of Pediatrics, University of Cincinnati, Cincinnati, Ohio

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.

Publisher

American Academy of Pediatrics (AAP)

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