Consensus definitions of complications for accurate recording and comparisons of surgical outcomes in pediatric neurosurgery.
OBJECTIVE
Monitoring and recording of complications in pediatric neurosurgery are important for quality assurance and in particular for improving outcomes. Lack of accurate or mutually agreed upon definitions hampers this process and makes comparisons between centers, which is an important method to improve outcomes, difficult. Therefore, the Canadian Pediatric Neurosurgery Study Group created definitions of complications in pediatric neurosurgery with consensus among 13 Canadian pediatric neurosurgical centers.


METHODS
Definitions of complications were extracted from randomized trials, prospective data collection studies, and the medical literature. The definitions were presented at an annual meeting and were subsequently recirculated for anonymous comment and revision, assembled by a third party, and re-presented to the group for consensus.


RESULTS
Widely used definitions of shunt failure were extracted from previous randomized trials and prospective studies. Definitions for wound infections were extracted from the definitions from the Centers for Disease Control and Prevention. Postoperative neurological deficits were based on the Pediatric Stroke Outcome Measure. Other definitions were created and modified by consensus. These definitions are now currently in use across the Canadian Pediatric Neurosurgery Study Group centers in Morbidity and Mortality data collection and for subsequent comparison studies.


CONCLUSIONS
Coming up with consensus definitions of complications in pediatric neurosurgery is a first step in improving the quality of outcomes. It is a dynamic process, and further refinements are anticipated. Center to center comparison will hopefully allow significant variations in outcomes to be identified and acted upon.
Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada. james.drake@sickkids.ca
James M
JM
Drake
Ash
A
Singhal
Abhaya V
AV
Kulkarni
Gabrielle
G
DeVeber
D Douglas
DD
Cochrane
D002648:Child; D006801:Humans; D008499:Medical Records / Q000592:standards*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009626:Terminology as Topic; D016896:Treatment Outcome