title: Outcome of hospital discharge on postoperative Day 1 following uncomplicated tethered spinal cord release.
abstract: OBJECTIVE Postoperative management following the release of simple spinal cord-tethering lesions is highly variable. As a quality improvement initiative, the authors aimed to determine whether an institutional protocol of discharging patients on postoperative day (POD) 1 was associated with a higher rate of postoperative CSF leaks than the prior protocol of discharge on POD 2. METHODS This was a single-center retrospective review of all children who underwent release of a spinal cord-tethering lesion that was not associated with a substantial fascial or dural defect (i.e., simple spinal cord detethering) during 2 epochs: prior to and following the institution of a protocol for discharge on POD 1. Outcomes included the need for and timing of nonroutine care of the surgical site, including return to the operating room, wound suturing, and nonsurgical evaluation and management. RESULTS Of 169 patients identified, none presented with CSF-related complications prior to discharge. In the preintervention group (n = 113), the postoperative CSF leak rate was 4.4% (5/113). The mean length of stay was 2.3 days. In the postintervention group, the postoperative CSF leak rate was 1.9% (1/53) in the patients with postdischarge follow-up. The mean length of stay in that group was 1.3 days. CONCLUSIONS At a single academic children's hospital, a protocol of discharging patients on POD 1 following uncomplicated release of a simple spinal cord-tethering lesion was not associated with an increased rate of postoperative CSF leaks, relative to the previous protocol. The rates identified are consistent with the existing literature. The authors' practice has changed to discharge on POD 1 in most cases.
authors: University of Colorado School of Medicine;
authors: Seerat
authors: S
authors: Poonia
authors: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and.
authors: Sarah
authors: S
authors: Graber
authors: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and.
authors: C
authors: C
authors: Corbett Wilkinson
authors: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and.
authors: Brent R
authors: BR
authors: O'neill
authors: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and.
authors: Michael H
authors: MH
authors: Handler
authors: Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus; and.|Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors: Todd C
authors: TC
authors: Hankinson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009436:Neural Tube Defects / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies
keywords: OSD = occult spinal dysraphism; POD = postoperative day; cerebrospinal fluid leak; occult spinal dysraphism; postoperative management; pseudomeningocele; spine; tethered spinal cord