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What is complex care?


Children with complex medical conditions face certain risks when undergoing prolonged surgeries such as spinal fusion or involved hip surgeries. This program ensures children with complex medical needs receive the highest-quality care. Our goal is to make sure patients are as strong and healthy as possible before surgery to help reduce recovery time and postoperative complications.

 

Program staff 

 

Our complex care coordinator works with the orthopedic surgeon to ensure all necessary preoperative evaluations are completed. Evaluations may begin several months before surgery to ensure patients' needs are met. Any additional evaluations needed will be scheduled for the family.

 

Complex medical conditions include

 

  • Chronic illnesses

  • Neuromuscular disorders

  • Multisystem health conditions

  • Heart and lung illnesses

What to expect at your appointment


When your child is placed in the Complex Care Program a referral is sent to the Complex Care Coordinator. She will review your child’s medical records and will determine along with your doctor what services are recommended before your child’s surgery. 

Your child will most likely be scheduled for appointments with other specialties, as well scheduled for some medical tests before their orthopaedic surgery. The appointments and tests that are recommended will vary, and are individualized depending upon your child’s diagnosis and planned surgical procedure. 


Common tests


Below is a list of common appointments or tests that may be recommended for your child. 

  • Pulmonary Function Test (PFT’s): PFT’s help to assess lung function. This test will determine how much air a person can breathe in and out and how far their lungs can expand. If your child is unable to participate in the PFT’s then an appointment to see the Pulmonologist will be arranged. The Pulmonologist will see your child and make suggestions if interventions are necessary before surgery or following surgery. 

  • Cardiology: below are two common tests that we may order to evaluation your child’s heart. 

    • Electrocardiogram (EKG): This test shows how the heart conduction system is working. Electrodes will be placed on your child’s chest, shoulders and legs. The electrodes (wires) are connected to a machine which traces your child’s heart rhythm. 

    • Echocardiogram (ECHO): This test looks at the structures of the heart and how well it is working. Ultrasound (US) is used for this test. Gel will be placed on the chest of the child and then a wand is rolled over the chest to get the data needed. Your child may feel some pressure as the wand is pressed on the chest, but it should not be uncomfortable. This test takes 30 to 45 minutes to complete. 

  • Laboratory Tests: Children with complex medical concerns will often be asked to have blood work done. We may order an initial set of labs, and then labs may be repeated the day before surgery. 

  • Nutrition: We may suggest a visit to Nutrition to evaluate your child’s diet and make recommendations. Studies have shown that children with complex medical needs who are under weight or over weight have more post-operative complications. Proper nutrition can aid in the healing process following surgery. When we suggest a consultation for your child with Nutrition, your child will be seen by a Dietitian. The Dietitian will ask questions about what your child normally eats.  Based on your child's normal dietary habits, their weight, height, and BMI, the Dietitian may suggest additional lab work, diet modifications, or possible supplements. The Dietitian makes these recommendations, and then your Primary Care Provider will help with ordering these tests. 

  • Physical Therapy (PT): The PT will assess how your child normally moves and transfers from bed to chair, etc. The PT will determine if your child will need to transfer a new way following surgery. If this is the case, then the PT will help teach the family and the child the new techniques before surgery. This can then be practiced at home before their surgery. This makes the transition to new methods of transfers easier to reinforce following surgery. 

  • Pre-admission testing (PAT): Children with complex medical conditions or who require pre-operative laboratory tests are among those who benefit from having a PAT visit before surgery. You and your child will meet with nurses and nurse practitioners to create a plan for the day of surgery. A pediatric anesthesiologist may also see your child at this visit. Please bring a list of all medications your child receives when you come to this appointment. 

Radiologic Tests

  • Computed Tomography (CT scan): A CT scan is a scan that looks inside the body to look at internal structures. Your child will need to lie flat on a table. This test does not hurt and is quick: it will be complete in about 10 minutes.

  • Dexa Scan: This is a scan that determines the strength of the bones. Your child will lie on a table and the scanner (camera) will move over their body. This test takes about 15-20 minutes. 

  • Magnetic Resonance Imaging (MRI): This test uses magnetic and radio waves to produce pictures of inside the body and its structures (bones, organs). This test takes longer than a CT scan; the length of the test depends on what part of the body is being examined. For example, the cervical spine exam could take 30 minutes, however if the whole spine is being examined, this test could take over an hour. Your child will need to lie very still during the test, and because of the length of the test, your child may need to be sedated for this exam to be done. 


Other Important Information

  • Acne: Acne on the back can be a significant cause of late infection following spine surgery. It is important that the acne be cleared up before surgery. If your child has acne on their back, we will ask them to see a dermatologist. This appointment will need to be done months before your child’s surgery date. 

  • Constipation: Often child with complex medical needs or impaired ambulation have problems with constipation. Following surgery, constipation will often be worse due to anesthesia slowing down the motility of the gut, pain medications tend to be constipating, and your child’s mobility is often decreased for several days following surgery. We will work with you to help come up with a plan to prevent constipation, and perhaps do some interventions several days to a week before surgery to treat constipation concerns before the day of surgery. 

  • Day of Surgery: The day before surgery your child will need to come to CMH to have lab work repeated. At this time we will also Type and Cross your child’s blood, so that blood would be on hand if needed for surgery. A red band will be placed on your child’s wrist. It is very important to not remove this red band. If it is removed, a new set of labs will need to be drawn the day of surgery and this will delay start time of their procedure. 

  • Medications: There are some medications that should be stopped 2 weeks before surgery because they may interfere with normal blood clotting and cause your child to bleed more during surgery. These include, aspirin, ibuprofen, Motrin, Aleve, Advil, Nuprin, Naprosyn, as well as some herbal remedies. Please make sure your physician in aware of any medications that your child is taking. Acetaminophen (Tylenol) may be given to your child before surgery without any concerns of it affecting bleeding.