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Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I
James Feghali1, Elizabeth Marinaro1, Yangyiran Xie2
1Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Postoperative emergency department visits are common after Chiari malformation type I surgery, often due to headaches. These visits predict worse clinical outcomes, highlighting a need for better management strategies.
Area of Science:
- Neurosurgery
- Patient Outcomes
- Healthcare Utilization
Background:
- Postoperative emergency department (ED) visits following suboccipital decompression for Chiari malformation type I (CM-1) are not well-documented.
- Understanding the frequency, causes, and impact of these ED visits is crucial for improving patient care after CM-1 surgery.
Purpose of the Study:
- To evaluate the rate, reasons, and significance of postoperative ED visits in adult CM-1 patients treated at a tertiary referral center.
- To identify factors associated with ED visits and their impact on long-term clinical outcomes.
Main Methods:
- A prospective database of 175 adult CM-1 patients undergoing surgery between 2006 and 2019 was analyzed.
- ED visits within 30 days post-surgery were tracked, comparing patient characteristics and clinical outcomes (using Chicago Chiari Outcome Scale) between those with and without ED visits.
Main Results:
- 25% of patients (44/175) had at least one ED visit within 30 days post-surgery.
- Headache was the most frequent reason for ED visits (41%). Concentration disturbance at presentation was the only significant predictor of an ED visit.
- Postoperative ED visits were independently associated with a lower likelihood of clinical improvement at long-term follow-up.
Conclusions:
- Adult CM-1 patients experience a high rate of postoperative ED visits, primarily for pain-related issues.
- These visits are difficult to predict but are linked to poorer long-term clinical outcomes.
- Strategies to reduce postoperative ED utilization in CM-1 patients are needed.
Background:
Postoperative emergency department (ED) visits following suboccipital decompression in Chiari malformation type I (CM-1) patients are not well described. We sought to evaluate the magnitude, etiology, and significance of postoperative ED service utilization in adult CM-1 patients at a tertiary referral center.
Methods:
A prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was also compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS).
Results:
In 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%), and concentration disturbance at presentation was the only factor significantly associated with a postoperative ED visit (P = 0.023). The occurrence of a postoperative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted odds ratio of CCOS ≥13 = 0.35, P = 0.021; adjusted odds ratio of CCOS ≥14 = 0.38, P = 0.016).
Conclusions:
Adult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of postoperative ED visits, which are mostly due to pain-related complaints. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of postoperative ED service utilization are warranted.
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