Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia

Rebecca A. Reynolds*, Arnold Bhebhe, Roxanna M. Garcia, Heidi Chen, Christopher M. Bonfield, Sandi Lam, Kachinga Sichizya, Chevis Shannon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objective: Spina bifida disproportionally affects low-and-middle-income countries. We describe myelomeningocele surgical outcomes in Zambia and predictors of postoperative complications and mortality. Methods: This 2-center retrospective cohort study includes children who underwent surgical treatment for myelomeningocele in Lusaka, Zambia from 2017 to 2019. Primary outcomes included mortality and 30-day postoperative complications. Results: Seventy-five patients were identified. Median age at first neurosurgical evaluation was 9 days (interquartile range [IQR], 6–21) and at surgery was 21 days (IQR 15–36). Lumbosacral myelomeningocele was most common (73%, n = 54). At first preoperative evaluation, 28% of the neural tube defects were deemed infected (n = 21), and 30% were leaking cerebrospinal fluid (n = 21). Postoperatively, 7% of patients died (n = 5), whereas 31% experienced a complication (n = 23). Most common complications included wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). Median follow-up duration was 41 days (IQR, 6–128). On univariable analysis, mortality was significantly associated with shorter follow-up duration (5 days [IQR, 2–7] vs. 46 days [IQR, 12–132]; P = 0.02) and any complication (P < 0.001). No variable was significantly associated with postoperative complication; however, 2 variables that notably neared significance were preoperative infection of the lesion (P = 0.05) and longer surgical delay (P = 0.06). Conclusions: Most patients born with myelomeningocele in Zambia present for first neurosurgical evaluation after 1 week of age. Preoperative infection of the lesion and postoperative complications are relatively common, and complications are a significant predictor of postoperative mortality. Further investigation into preoperative efforts to mitigate risk of postoperative complications and mortality is warranted.

Original languageEnglish (US)
Pages (from-to)e332-e339
JournalWorld neurosurgery
Volume145
DOIs
StatePublished - Jan 2021

Funding

The authors would like to thank the Fogarty International Center and the Vanderbilt University, Emory University, Cornell University, and Duke University (VECD) Consortium for their project support. They would also like to thank CURE International for their assistance with research materials and database maintenance. The authors would also like to thank Mrs. Angela Chazura and Mrs. Charity Kamongu for their assistance with data collection. Conflict of interest statement: This work was supported by the Fogarty International Center at the National Institutes of Health under grant numbers R25TW009337 and D43TW010543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • Myelomeningocele
  • Neural tube defect
  • Spina bifida
  • Sub-Saharan Africa
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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