Faculty Collaboration Database

Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database. Childs Nerv Syst 2016 Nov;32(11):2165-2171

Date

11/01/2016

Pubmed ID

27392442

DOI

10.1007/s00381-016-3156-5

Scopus ID

2-s2.0-84978127725 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

PURPOSE: The multicenter National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database maintained by the American College of Surgeons was used to describe 30-day outcomes following Chiari type 1 decompression in children and to identify risk factors for readmission, reoperation, and perioperative complications.

METHODS: We identified patients aged 0-18 years who underwent posterior cranial fossa decompression for Chiari type 1 malformation in 2012, 2013, and 2014 in the NSQIP-Pediatric database. Multivariate regression analysis was performed using preoperative and perioperative data to determine risk factors for perioperative adverse events within 30 days of the index procedure.

RESULTS: We identified 1459 patients from the NSQIP-P database for the years 2012-2014. Fifty-five percent of the patients were female. Mean age was 9.8 years (median 10 years). Median operative time was 141 min (IQR 107-181 min). Postoperative complications were noted in 5.3 % and unplanned reoperations in 3.4 % of the patients. Postoperative ventriculoperitoneal shunt placement occurred in 0.9 % of the patients. Wound problems were the most common complication (3.8 % of all patients). Univariate analysis showed the following factors were associated with perioperative adverse events: longer operative times, hospital stay ≥5 days, hydrocephalus, and neurological, renal, and congenital comorbidities. On multivariate analysis, female sex (OR 1.46, 95 % CI 1.01-2.11), increased operative time (OR 1.01, 95 % CI 1.00-1.01), and hospital stay ≥5 days (OR 2.62, 95 % CI 1.55-4.43) were independent factors associated with perioperative adverse events.

CONCLUSION: The NSQIP-P database was used to describe surgical outcomes of posterior cranial fossa decompression in a US nationwide sample of 1459 children with Chiari type 1 malformation. The overall recorded adverse rate was low. Longer operative times and length of hospital stay ≥5 days during the index admission were associated with perioperative adverse events.

Author List

Vedantam A, Mayer RR, Staggers KA, Harris DA, Pan IW, Lam SK

Author

Aditya Vedantam MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Arnold-Chiari Malformation
Child
Child, Preschool
Cranial Fossa, Posterior
Databases, Factual
Decompression, Surgical
Female
Humans
Male
Neurosurgical Procedures
Postoperative Complications
Treatment Outcome