Can the Physiological Vulnerability Score predict outcomes of hip reconstruction in children with severe neuromuscular disability?

Stephanie Buchan, A Bevan, Alex Aarvold, Caroline Edwards, Simon Bennet 

University Hospital Southampton

Children with a severe neuromuscular disability frequently undergo hip reconstruction surgery to prevent migration and chronic pain. These patients often have complex co-morbidities, meaning surgery carries a high risk of severe complications. It can be difficult to know when the risk outweighs the benefit. This study looked to correlate the Physiological Vulnerability Score (PVS) with outcomes of hip reconstruction surgery in children with a severe neurodisability.

For this service evaluation, pre-operative physiological vulnerability scores were correlated against length of stay (LOS) and postoperative complications. Regression analysis was used to substratify patients undergoing femoral versus femoral and pelvic osteotomies.

There were 68 patients included, with a PVS of 0 to 21. Increased PVS had no correlation with either LOS (p=0.169) or severity of complications (p=0.981) for patients that underwent VDRO’s (n=48). However, for patients who also had a pelvic osteotomy (n=20), higher PVS was associated with increased LOS (p=0.009) and severity of complications (p=0.0002).

For patients with significant medical vulnerability, the PVS was associated with a higher rate of postoperative complications and longer LOS following femoral and pelvic hip reconstruction, but not following isolated bilateral femoral osteotomies. The results support early intervention before significant acetabular changes occur. The physiological vulnerability score can be used to augment clinical decision-making and enable a more informed surgical consent by the child’s parents.