title: Effects of preoperative gait analysis on costs and amount of surgery.
abstract: BACKGROUND
  The purpose of this study was to determine the effects of clinical gait analysis (GA) on the costs of care in ambulatory children with cerebral palsy (CP) and the amount of surgery these children undergo.
  
  
  METHODS
  A retrospective review identified all ambulatory patients with CP who had undergone lower extremity orthopaedic surgery at our hospital from 1991 to 2005 with at least a 6-month follow-up. The patients were grouped into those who had undergone GA before their index surgery (GA group, N=313) and those who had not (NGA group, N=149). The groups were compared in terms of the number of procedures during index surgery and subsequent surgeries and the direct costs associated with these surgeries. Costs were calculated in US dollars by using a standardized protocol including fees for the surgeon, anesthesia, operating room, hospital stay, physical therapy, and GA.
  
  
  RESULTS
  Patients in the GA group were significantly older and less functionally involved, had their first surgery in later years, and had a shorter follow-up than patients in the NGA group (P<0.001). Adjusting for these differences, patients in the GA group had more procedures (GA: 5.8, NGA: 4.2; P<0.001) and higher cost (GA: $43,006, NGA: $35,215; P<0.001) during index surgery, but less subsequent surgery. A higher proportion of patients went on to additional surgery in the NGA group (NGA: 32%, GA: 11%; P<0.001), with more additional surgeries per person-year (NGA: 0.3/person-year, GA: 0.1/person-year; P<0.001) resulting in higher additional costs (NGA: $3009/person-year, GA: $916/person-year; P<0.001). The total number of procedures (GA: 2.6/person-year, NGA: 2.3/person-year; P=0.22) and cost (GA: $20,448/person-year, NGA: $19,535/person-year; P=0.58) did not differ significantly between the 2 groups.
  
  
  CONCLUSIONS
  Clinical GA is associated with a lower incidence of additional surgery, resulting in lesser disruption to patients' lives. This finding has not been shown before and may assist patients, physicians, policy makers, and insurance companies in assessing the role of GA in the care of ambulatory children with CP.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. twren@chla.usc.edu
authors.forename: Tishya A L
authors.initials: TA
authors.lastname: Wren
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kalisvaart
authors.forename: Christine E
authors.initials: CE
authors.lastname: Ghatan
authors.forename: Susan A
authors.initials: SA
authors.lastname: Rethlefsen
authors.forename: Reiko
authors.initials: R
authors.lastname: Hara
authors.forename: Minya
authors.initials: M
authors.lastname: Sheng
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kay
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics / Q000379:methods*; D002547:Cerebral Palsy / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006801:Humans; D008297:Male; D012189:Retrospective Studies