Orthopedic Surgery

Safety in Orthopedic Surgery

Safety is a top priority for every member of the Division of Orthopedic Surgery at The Children's Hospital of Philadelphia (CHOP). It is the basis of everything we do and every decision we make regarding your child's care.

Nowhere is safety more important than during surgery — when your child is often at his most vulnerable.

CHOP's Division of Orthopedic Surgery is one of the largest and more experienced pediatric orthopedic centers in the United States. Each year, we treat more than 70,000 patients and perform more than 3,500 surgeries.

Our orthopedic surgeons are nationally-ranked experts in spinal deformities, musculoskeletal tumors, orthopedic trauma, sports medicine, bone disorders and a wide range of birth defects that affect a child’s bones, muscles, tendons and ligaments. Team members are actively pursuing more than 100 basic research and clinical research projects.

Through innovation and perseverance, we are changing the course of treatment for many children with complex orthopedic conditions.

Comprehensive and individualized care

At CHOP, we take a comprehensive, multidisciplinary approach to care for your child. We treat your child in his entirety — not just the injury, deformity or condition that brought your child here.

After evaluating and diagnosing your child, our expert orthopedic team investigates all treatment options before recommending the best course of treatment for your child. If surgery is needed, our orthopedic surgeons will use the least invasive approach to repair the defect or injury and help your child recover as quickly as possible.

While surgery can dramatically improve your child’s condition, it can be a stressful experience for both child and parent. We offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

Before surgery: care coordination

Before surgery, we work to ensure your child is as healthy and strong as possible. By taking precautions before surgery, we can help speed your child's recovery after surgery and reduce the risk of infection or any long-term side effects.

Depending on your child’s condition, we may recommend a nutritional or exercise program be started before surgery to build your child’s strength. For example, we may request your child stop taking any over-the-counter medications or herbal remedies, which may interfere with anesthetics or medications needed before, during or after surgery.

If your child has health issues beyond the orthopedic condition being treated — e.g. cancer, cerebral palsy, kidney disease — our orthopedic team will work closely with your child’s other healthcare providers to coordinate care. The Hospital has a strong multidisciplinary team that consults and collaborates to ensure the best outcomes for your child.

During surgery: minimizing risks

With any surgical procedure, there are general risks and procedure-specific risks. Our goal is to minimize, if not eliminate, those complications.

Surgical site infections are a very real issue in the United States. As many as 5 percent of patients undergoing surgery in the U.S. will experience a surgical site infection, leading to an increased risk of serious health complications, more days in the hospital, and increased healthcare costs.

At CHOP, we employ numerous best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. Some safety protocols we use include anesthesia monitoring, perioperative antibiotics, advanced navigation and imaging, ongoing monitoring, and postoperative clinical pathways.

Continuous anesthesia monitoring

Before surgery, it is natural for you to be concerned about the effects of anesthesia on your child. At CHOP, the anesthesiologists who care for your child are fellowship-trained in pediatric anesthesia and well versed in providing anesthesia to children.

Our dedicated and caring doctors, nurses and therapists have many years of experience treating children. We can help minimize your child’s pain, fear and anxiety.

The surgical team at CHOP employs many best practices to:

Perioperative antibiotics

One way to help reduce the risk of infection from an orthopedic surgical procedure is by administering perioperative antibiotics to patients before surgery.

National studies by CHOP physicians and groups like the American Academy of Orthopaedic Surgeons (AAOS) have shown that using preventative antibiotics within one hour before surgery on patients without known infections has reduced the incidence of infection.

While giving patients perioperative antibiotics is considered routine for many orthopedic procedures, CHOP surgeons continue to research the best antibiotics to use, and the best route of administration. For example, our surgeons have found applying vancomycin powder directly to the surgical site has produced better results than intravenous delivery of the drug.

Advanced navigation and imaging

During surgery, our surgical team uses the latest, high-tech imaging equipment — such as StealthStation® and O-arm® Surgical Imaging — to provide real-time images to aid surgeons and staff in safe placement of instruments and to support their decision-making during surgery.

By seeing exactly where they are operating, our team functions more accurately, reduces the amount of radiation exposure to your child, and shortens the time your child is under anesthesia.

Ongoing monitoring during surgery

Our surgical and clinical teams take every precaution to continually monitor your child's brain and muscles during surgery. Any member of the team can call a "time out" to reassess the patient or address any issues that develop during surgery.

Our team uses highly specialized monitoring called transcranial motor evoked potentials (TcMEP). TcMEP is currently one of the most effective ways to evaluate the patient’s motor pathways. This is especially important during spinal surgery.

TcMEP monitoring stimulates the motor cortex and descending motor axons of the patient's brain by using a mild electric current on the scalp. The currents are not painful to the child, and are used to stimulate a muscle response from the child's arms and legs. The motor potentials can be recorded by electrodes placed over the child's spinal cord or from electrodes in muscle groups in the child's hands and feet. Because of the large number of responses, clinicians can obtain feedback almost instantaneously.

The combination of spinal cord monitoring and real-time imaging enables our team to provide children with an unparalleled level of safety.

Further details

Learn more about how CHOP is preventing surgical site infections. For step-by-step details about safety in the operating room, see our surgical safety checklist.

After surgery: coordinated follow-up

After surgery is over, there are several ways the orthopedic team at CHOP works to ensure your child’s safety and comfort.

Pain management

Immediately after surgery, your child may have some discomfort, but our professionals in the Newborn/Infant Intensive Care Unit and the Pediatric Intensive Care Unit are specially trained to manage the pain of babies and children. Our goal is to keep your child as comfortable and safe as possible.

Depending on the age and developmental stage of your child, we may give him or her patient-controlled analgesia (PCA) for the first few days after surgery. This is an intravenous way to deliver pain medication to your child without repeated injections or pills. Your older child or teen can push the PCA to safely receive pain medication when needed.

Postoperative clinical pathways

Postoperative clinical pathways are standardized order sets developed by our team after reviewing best practices at CHOP and across the nation. Each order set for orthopedic patients is used to reduce variations in care.

The pathways and order sets include all services, including anesthesia, nursing, physical and occupational therapy, nutrition, pharmacy, case management and follow-up care. The pathways don’t eliminate individualized care for each patient, but rather serve as a framework so each patient receives the direct care he or she needs in the hospital and after discharge.

Standardized clinical pathways have led to significant reductions in the length of hospital stays, more efficient management of hospitalized patients, and better outcomes for patients.

Long-term follow-up care

Most children are able to go home shortly after surgery, but will need long-term follow-up care to ensure the best results.

In most cases, your child will see the orthopedic surgeon about one to two weeks after surgery, then again at three and six months post-surgery. Annual monitoring by trained clinicians is strongly encouraged because some orthopedic conditions can reoccur — even after being successfully treated. It is important for your child to see a physician regularly, especially if any symptoms reoccur.

During follow-up visits, X-rays and other diagnostic testing may be needed to closely monitor your child’s health and ensure there are no lingering effects from surgery or other treatments.

Follow-up care and ongoing support and services are available at our Main Campus and throughout our CHOP Care Network.

Continued research

Orthopedic surgeons, physicians and researchers at CHOP continue to investigate new diagnostic tools, new treatment approaches and ways to make surgery safer for all children with orthopedic conditions. CHOP orthopedic physicians continue to produce award-winning research to stay on the cutting-edge of patient clinical care and safety.

Our attention to research-based practices — as well as our individualized attention to your child's condition and specific needs — produces excellent results. Our goal is to improve the care and outcomes for all children with orthopedic deformities, diseases or injuries.


For more information on safety in orthopedic surgery at CHOP, visit:

Contact us

To make an appointment with the Division of Orthopedic Surgery at The Children's Hospital of Philadelphia, call 215-590-1527 or contact us online.


Reviewed by: Keith D. Baldwin, MD, MPH, MSPT, and John P. Dormans, MD, FACS
Date: May 2013

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