Thirty-day outcomes after postnatal myelomeningocele repair: a National Surgical Quality Improvement Program
Jacob Cherian1,2, Kristen A Staggers1,2, I-Wen Pan1,2
1Division of Pediatric Neurosurgery, Texas Children's Hospital, and.
Insights
Myelomeningocele repair in infants is associated with a 27% complication rate within 30 days. Early surgical repair within 24 hours of birth increases complication risk, highlighting the need for careful timing in pediatric spina bifida surgery.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Public Health
Background:
- Myelomeningocele repair, while less common due to improved care, still presents surgical challenges.
- Previous outcome studies often relied on limited, single-hospital data.
- A national, prospective database offers a broader view of current surgical outcomes.
Purpose of the Study:
- To analyze 30-day outcomes for pediatric patients undergoing postnatal myelomeningocele repair.
- To identify preoperative and intraoperative factors associated with complications, readmissions, and returns to the operating room.
- To investigate the impact of repair timing and defect size on outcomes.
Main Methods:
- Utilized the 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database.
- Included patients undergoing postnatal myelomeningocele repair, categorized by defect size (<5 cm vs. >5 cm).
- Analyzed 30-day complications, unplanned readmissions, and returns to the OR using logistic regression, examining CSF diversion procedures.
Main Results:
- 114 patients were analyzed; 27% experienced complications, most commonly wound issues.
- 35% required subsequent surgery within 30 days, with 21% returning for initial shunt placement.
- Complications and returns to the OR were linked to the patient's age at repair; earlier repair (within 24 hours) showed higher complication rates.
Conclusions:
- The NSQIP-P database provides valuable insights into national perioperative outcomes for myelomeningocele repair.
- Over a quarter of infants experienced complications within 30 days post-repair.
- Surgical repair within the first 24 hours was associated with a significantly higher complication rate, suggesting timing is a critical factor.
Abstract:
OBJECTIVE Due to improved nutrition and early detection, myelomeningocele repair is a relatively uncommon procedure. Although previous studies have reviewed surgical trends and predictors of outcomes, they have relied largely on single-hospital experiences or on databases centered on hospital admission data. Here, the authors report 30-day outcomes of pediatric patients undergoing postnatal myelomeningocele repair from a national prospective surgical outcomes database. They sought to investigate the association between preoperative and intraoperative factors on the occurrence of 30-day complications, readmissions, and unplanned return to operating room events. METHODS The 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (NSQIP-P) was queried for all patients undergoing postnatal myelomeningocele repair. Patients were subdivided on the basis of the size of the repair (< 5 cm vs > 5 cm). Preoperative variables, intraoperative characteristics, and postoperative 30-day events were tabulated from prospectively collected data. Three separate outcomes for complication, unplanned readmission, and return to the operating room were analyzed using univariate and multivariate logistic regression. Rates of associated CSF diversion operations and their timing were also analyzed. RESULTS A total of 114 patients were included; 54 had myelomeningocele repair for a defect size smaller than 5 cm, and 60 had repair for a defect size larger than 5 cm. CSF shunts were placed concurrently in 8% of the cases. There were 42 NSQIP-defined complications in 31 patients (27%); these included wound complications and infections, in addition to others. Postoperative wound complications were the most common and occurred in 27 patients (24%). Forty patients (35%) had at least one subsequent surgery within 30 days. Twenty-four patients (21%) returned to the operating room for initial shunt placement. Unplanned readmission occurred in 11% of cases. Both complication and return to operating room outcomes were statistically associated with age at repair. CONCLUSIONS The NSQIP-P allows examination of 30-day perioperative outcomes from a national prospectively collected database. In this cohort, over one-quarter of patients undergoing postnatal myelomeningocele repair experienced a complication within 30 days. The complication rate was significantly higher in patients who had surgical repair within the first 24 hours of birth than in patients who had surgery after the 1st day of life. The authors also highlight limitations of investigating myelomeningocele repair using NSQIP-P and advocate the importance of disease-specific data collection.
