TY - JOUR
T1 - Chiari malformation Type I surgery in pediatric patients. Part 2
T2 - Complications and the influence of comorbid disease in California, Florida, and New York
AU - Greenberg, Jacob K.
AU - Olsen, Margaret A.
AU - Yarbrough, Chester K.
AU - Ladner, Travis R.
AU - Shannon, Chevis N.
AU - Piccirillo, Jay F.
AU - Anderson, Richard C.E.
AU - Wellons, John C.
AU - Smyth, Matthew D.
AU - Park, Tae Sung
AU - Limbrick, David D.
N1 - Funding Information:
We thank Mr. Nicholas White for assistance with database programming. We thank Dr. Yan Yan for his input regarding the statistical analyses conducted in this study. This work was supported by the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) under Award Numbers UL1 TR000448 and TL1 TR000449 and by funding from the Agency for Healthcare Research and Quality (R24 HS19455). This work was also supported in part through grants from the American Syringomyelia and Chiari Alliance Project (ASAP) and Washington University School of Medicine as well as philanthropic funding provided by the Park-Reeves Syringomyelia Research Consortium, the O'Keefe family, and Mateo Dalla Fontana. T.R.L. was also supported by a Council of State Neurosurgical Societies/Congress of Neurological Surgeons Medical Student Fellowship. None of the funding agencies had a direct role in the study design and conduct; data collection, management, analysis, or interpretation; preparing, reviewing, or approving the manuscript prior to submission; or the decision to submit the manuscript for publication.
Publisher Copyright:
© AANS, 2016.
PY - 2016/5
Y1 - 2016/5
N2 - Objective Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, singlecenter studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using populationlevel administrative billing data. Methods The authors used Healthcare Cost and Utilization Project State Inpatient Databases (SID) to study pediatric patients undergoing surgical decompression for CM-I from 2004 to 2010 in California, Florida, and New York. They assessed the prevalence and influence of preoperative complex chronic conditions (CCC) among included patients. Outcomes included medical and surgical complications within 90 days of treatment. Multivariate logistic regression was used to identify risk factors for surgical complications. Results A total of 936 pediatric CM-I surgeries were identified for the study period. Overall, 29.2% of patients were diagnosed with syringomyelia and 13.7% were diagnosed with scoliosis. Aside from syringomyelia and scoliosis, 30.3% of patients had at least 1 CCC, most commonly neuromuscular (15.2%) or congenital or genetic (8.4%) disease. Medical complications were uncommon, occurring in 2.6% of patients. By comparison, surgical complications were diagnosed in 12.7% of patients and typically included shunt-related complications (4.0%), meningitis (3.7%), and other neurosurgeryspecific complications (7.4%). Major complications (e.g., stroke or myocardial infarction) occurred in 1.4% of patients. Among children with CCCs, only comorbid hydrocephalus was associated with a significantly increased risk of surgical complications (OR 4.5, 95% CI 2.5-8.1). Conclusions Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although CCCs were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts.
AB - Objective Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, singlecenter studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using populationlevel administrative billing data. Methods The authors used Healthcare Cost and Utilization Project State Inpatient Databases (SID) to study pediatric patients undergoing surgical decompression for CM-I from 2004 to 2010 in California, Florida, and New York. They assessed the prevalence and influence of preoperative complex chronic conditions (CCC) among included patients. Outcomes included medical and surgical complications within 90 days of treatment. Multivariate logistic regression was used to identify risk factors for surgical complications. Results A total of 936 pediatric CM-I surgeries were identified for the study period. Overall, 29.2% of patients were diagnosed with syringomyelia and 13.7% were diagnosed with scoliosis. Aside from syringomyelia and scoliosis, 30.3% of patients had at least 1 CCC, most commonly neuromuscular (15.2%) or congenital or genetic (8.4%) disease. Medical complications were uncommon, occurring in 2.6% of patients. By comparison, surgical complications were diagnosed in 12.7% of patients and typically included shunt-related complications (4.0%), meningitis (3.7%), and other neurosurgeryspecific complications (7.4%). Major complications (e.g., stroke or myocardial infarction) occurred in 1.4% of patients. Among children with CCCs, only comorbid hydrocephalus was associated with a significantly increased risk of surgical complications (OR 4.5, 95% CI 2.5-8.1). Conclusions Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although CCCs were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts.
KW - Chiari malformation type I
KW - Health services research
KW - Neurosurgery
KW - Postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=84971425220&partnerID=8YFLogxK
U2 - 10.3171/2015.10.PEDS15369
DO - 10.3171/2015.10.PEDS15369
M3 - Article
C2 - 26799408
AN - SCOPUS:84971425220
SN - 1933-0707
VL - 17
SP - 525
EP - 532
JO - Journal of Neurosurgery: Pediatrics
JF - Journal of Neurosurgery: Pediatrics
IS - 5
ER -