title: Perioperative factors associated with prolonged intensive care unit and hospital length of stay after pediatric neurosurgery.
abstract: OBJECTIVE
  This study aims to describe the association between different postoperative complications and the length of hospital stay among children undergoing neurosurgical procedures.
  
  
  METHODS
  A retrospective cohort study was carried out between May 2004 and May 2009 in a tertiary community hospital. All postoperative complications following neurosurgical procedures and their association with the main outcomes [length of intensive care unit (ICU) and hospital stay] were investigated in a univariate and multivariate analysis.
  
  
  RESULTS
  The medical records of 198 patients treated during the study period were reviewed. The most frequently performed surgeries were ventriculoperitoneal shunting (16.7%), correction of craniosynostosis (30%) and brain tumor resections (28.3%). Of the 198 patients eligible for this analysis, 79 (39.9%) suffered from at least one complication. The most frequent complications were fever (30.3%), hypothermia (16%), postextubation laryngitis (15.1%) and postoperative bleeding (7%). Factors independently associated with a longer pediatric ICU stay were fever (odds ratio 1.39, 95% confidence interval 1.1-3.2; p = 0.001), laryngitis (odds ratio 2.24, 95% confidence interval 1.8-5.2; p = 0.001), postoperative bleeding requiring reoperation (odds ratio 1.8, 95% confidence interval 1.4-3.9; p < 0.001) and infection (odds ratio 3.71, 95% confidence interval 1.8-12.4; p = 0.033). Fever (odds ratio 2.54, 95% confidence interval 2-7.4; p = 0.001) and infection (odds ratio 11.23, 95% confidence interval 4-22.4; p = 0.003) were related to the total length of the patient's hospital stay.
  
  
  CONCLUSIONS
  In this study population, most elective neurosurgical procedures were not associated with significant complications, and morbidity and mortality were low. Some complications significantly influenced patients' outcomes and should be monitored for early diagnosis. This study may improve our understanding and identification of postoperative outcomes in pediatric neurosurgery.
authors: Pediatric Emergency Department, University Hospital, São Paulo University, São Paulo, Brazil. emf2002@uol.com.br
authors: Eduardo
authors: E
authors: Mekitarian Filho
authors: Werther
authors: W
authors: Brunow de Carvalho
authors: Sérgio
authors: S
authors: Cavalheiro
authors: Nelson Kazunobu
authors: NK
authors: Horigoshi
authors: Norberto Antonio
authors: NA
authors: Freddi
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003398:Craniosynostoses / Q000401:mortality / Q000601:surgery; D004827:Epilepsy / Q000401:mortality / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009017:Morbidity; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D017287:Ventriculoperitoneal Shunt / Q000706:statistics & numerical data