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Complication rates following Chiari malformation surgical management for Arnold-Chiari type I based on surgical
Peter G Passias1, Sara Naessig1, Ashok Para1
1Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.
Insights
Complication rates for Chiari Malformation Type 1 patients decreased significantly from 2003-2012. Patients with higher comorbidity and specific diagnoses faced increased risks, particularly after instrumented fusions.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Health Outcomes Research
Background:
- Chiari Malformation Type 1 (CM-1) is a condition requiring surgical intervention.
- Understanding complication trends is crucial for optimizing patient care.
- National-level data analysis provides insights into surgical outcomes for CM-1.
Purpose of the Study:
- To identify trends in postoperative complications for Chiari Malformation Type 1 patients.
- To analyze the relationship between specific surgical procedures and complication rates.
- To investigate the impact of concomitant diagnoses on CM-1 patient outcomes.
Main Methods:
- Utilized the Kids' Inpatient Database for CM-1 diagnoses (ICD-9 code 348.4).
- Employed Chi-squared and t-tests for demographic and complication rate comparisons.
- Applied binary logistic regression to identify significant factors influencing complication rates.
Main Results:
- Overall complication rates for CM-1 decreased from 9.6% to 5.1% between 2003 and 2012.
- Patients with complications were younger, had lower invasiveness scores, but higher Charlson Comorbidity Index.
- Concurrent diagnoses of syringomyelia and scoliosis were associated with higher complication rates.
Conclusions:
- Craniotomies and instrumented fusions in CM-1 patients are linked to increased postoperative complications.
- Instrumented fusions involving more than four levels pose a particularly high risk.
- Decompression surgeries showed lower postoperative complication rates.
Introduction:
This study aimed to identify complication trends of Chiari Malformation Type 1 patients (CM-1) for certain procedures and concomitant diagnoses on a national level.
Materials:
The Kids' Inpatient Database was queried for diagnoses of operative CM-1 by International Classification of Disease-9 codes (348.4). Differences in preoperative demographics and perioperative complication rates between patient cohorts were assessed using Pearson's Chi-squared test and t-test when necessary. Binary logistic regression was utilized to find significant factors associated with complication rate. Certain surgical procedures were analyzed for their relationship with postoperative outcomes.
Results:
Thirteen thousand eight hundred and twelve CM-1 patients were identified with 8.2% suffering from a complication. From 2003 to 2012, the rate of complications for CM-1 pts decreased significantly (9.6%-5.1%) along with surgical rate (33.3%-28.6%), despite the increase in CM-1 diagnosis (36.3%-42.3%; all P < 0.05). CM-1 pts who had a complication were younger and had a lower invasiveness score; however, they had a larger Charlson Comorbidity Index than those who did not have a complication (all P < 0.05). CM-1 pts who experienced complications had a concurrent diagnosis of syringomyelia (7.1%), and also scoliosis (3.2%; all P < 0.05). CM-1 pts who did not have a complication had a greater rate of operation than those that had a complication (76.4% vs. 23.6% P < 0.05). The most common complications were nervous system related (2.8%), anemia (2.4%), and acute respiratory distress (2.1%). CM-1 pts that underwent an instrumented fusion (3.4% vs. 2.1%) had a greater complication rate as well as compared to those who underwent a craniotomy (23.2% vs. 19.1%; all P < 0.05). However, CM-1 pts that underwent a decompression had lower postoperative complications (21.3% vs. 28.9%; all P < 0.05).
Conclusions:
Chiari patients undergoing craniectomies as well as instrumented fusions are at a higher risk of postoperative complications especially when the instrumented fusions were performed on >4 levels.
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