Practice trends in the utilization of intraoperative neurophysiological monitoring in pediatric neurosurgery as a function of complication rate, and patient-, surgeon-, and procedure-related factors.
OBJECTIVE
Higher benchmarks in safety for patients undergoing neurosurgery have been introduced. With these principles, new tools and techniques were established, including intraoperative neurophysiological monitoring (IONM). Current trends as a function of patient-, surgeon-, and procedure-related factors and complication rates in the utilization of IONM as an adjunct to the practice of pediatric neurosurgery have not been investigated previously.


METHODS
Between 2008 and 2011, 4467 neurosurgical procedures were performed on 2352 patients at Texas Children's Hospital. A retrospective chart review was performed in which surgeon, procedure, and patient characteristics, as well as perioperative complications, were recorded for IONM and non-IONM cases.


RESULTS
Neurosurgical procedures performed with IONM steadily increased. Surgeon-related factors associated with IONM use included surgeons with <10 years of practice (P < .0001), and subspecialty interest in spine (P < .0001) and oncology (P = .0048). Procedure-related factors associated with IONM use included operations involving the spinal cord (P < .0001). Patient-related factors associated with IONM use included children older than 3 years of age and with increased American Society of Anesthesiologists score (P < .0001). The neurological complication rate in the IONM cohort (range 3.4% to 11.3%; mean 6.4%) was significantly higher compared to the non-IONM cohort (range 1.1% to 1.8%; mean 1.5%) (P < .0001).


CONCLUSIONS
The percent of procedures performed with IONM increased. However, these trends do not seem governed by improvement to patient outcomes because the complication rates were higher in the IONM cohort than the non-IONM cohort.
Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Sudhakar
S
Vadivelu
Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Ahilan
A
Sivaganesan
Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Akash J
AJ
Patel
Division of Neurophysiology, Texas Children's Hospital, Houston, Texas, USA; Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Satish
S
Agadi
Division of Neurophysiology, Texas Children's Hospital, Houston, Texas, USA; Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Robert J
RJ
Schmidt
Division of Neurophysiology, Texas Children's Hospital, Houston, Texas, USA; Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Prasitha
P
Mani
Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. Electronic address: ajea@bcm.edu.
Andrew
A
Jea
D000293:Adolescent; D000328:Adult; D019985:Benchmarking; D002493:Central Nervous System Diseases / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor; D006801:Humans; D007223:Infant; D064795:Intraoperative Neurophysiological Monitoring / Q000592:standards / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D010372:Pediatrics; D011183:Postoperative Complications / Q000453:epidemiology*; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
Intraoperative monitoring; Pediatric neurosurgery; Practice trends