Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database

Aditya Vedantam, Rory R. Mayer, Kristen A. Staggers, Dominic A. Harris, I. Wen Pan, Sandi K. Lam*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus 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.

Original languageEnglish (US)
Pages (from-to)2165-2171
Number of pages7
JournalChild's Nervous System
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Keywords

  • Chiari malformation
  • NSQIP
  • Pediatric
  • Perioperative
  • Posterior fossa decompression
  • Readmission
  • Reoperation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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