title: Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York.
abstract: OBJECTIVE Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, single-center studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using population-level administrative billing data. METHODS The authors used Healthcare Cost and Utilization Project State Inpatient Databases (SID) to study pediatric patients undergoing surgical decompression for CM-I from 2004 to 2010 in California, Florida, and New York. They assessed the prevalence and influence of preoperative complex chronic conditions (CCC) among included patients. Outcomes included medical and surgical complications within 90 days of treatment. Multivariate logistic regression was used to identify risk factors for surgical complications. RESULTS A total of 936 pediatric CM-I surgeries were identified for the study period. Overall, 29.2% of patients were diagnosed with syringomyelia and 13.7% were diagnosed with scoliosis. Aside from syringomyelia and scoliosis, 30.3% of patients had at least 1 CCC, most commonly neuromuscular (15.2%) or congenital or genetic (8.4%) disease. Medical complications were uncommon, occurring in 2.6% of patients. By comparison, surgical complications were diagnosed in 12.7% of patients and typically included shunt-related complications (4.0%), meningitis (3.7%), and other neurosurgery-specific complications (7.4%). Major complications (e.g., stroke or myocardial infarction) occurred in 1.4% of patients. Among children with CCCs, only comorbid hydrocephalus was associated with a significantly increased risk of surgical complications (OR 4.5, 95% CI 2.5-8.1). CONCLUSIONS Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although CCCs were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts.
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Greenberg
authors.affiliation: Medicine, and.|Surgery, Washington University School of Medicine in St. Louis, Missouri;
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Olsen
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Chester K
authors.initials: CK
authors.lastname: Yarbrough
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Travis R
authors.initials: TR
authors.lastname: Ladner
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: Chevis N
authors.initials: CN
authors.lastname: Shannon
authors.affiliation: Otolaryngology-Head and Neck Surgery.
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, New York, New York.
authors.forename: Richard C E
authors.initials: RC
authors.lastname: Anderson
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Park
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: David D
authors.initials: DD
authors.lastname: Limbrick
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications* / Q000601:surgery*; D002140:California; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005431:Florida; D006801:Humans; D006849:Hydrocephalus / Q000150:complications*; D007223:Infant; D016015:Logistic Models; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009518:New York; D012307:Risk Factors; D012600:Scoliosis / Q000209:etiology; D013595:Syringomyelia / Q000209:etiology
keywords: CCC = complex chronic condition; CM-I = Chiari malformation Type I; CM-II = Chiari malformation Type II; Chiari malformation Type I; HCUP = Healthcare Cost and Utilization Project; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; SID = State Inpatient Databases; health services research; neurosurgery; postoperative complications