title: Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database.
abstract: OBJECTIVE
  The multicenter National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database maintained by the American College of Surgeons was used to describe 30-day outcomes following Chiari type 1 decompression in children and to identify risk factors for readmission, reoperation, and perioperative complications.
  
  
  METHODS
  We identified patients aged 0-18 years who underwent posterior cranial fossa decompression for Chiari type 1 malformation in 2012, 2013, and 2014 in the NSQIP-Pediatric database. Multivariate regression analysis was performed using preoperative and perioperative data to determine risk factors for perioperative adverse events within 30 days of the index procedure.
  
  
  RESULTS
  We identified 1459 patients from the NSQIP-P database for the years 2012-2014. Fifty-five percent of the patients were female. Mean age was 9.8 years (median 10 years). Median operative time was 141 min (IQR 107-181 min). Postoperative complications were noted in 5.3 % and unplanned reoperations in 3.4 % of the patients. Postoperative ventriculoperitoneal shunt placement occurred in 0.9 % of the patients. Wound problems were the most common complication (3.8 % of all patients). Univariate analysis showed the following factors were associated with perioperative adverse events: longer operative times, hospital stay ≥5 days, hydrocephalus, and neurological, renal, and congenital comorbidities. On multivariate analysis, female sex (OR 1.46, 95 % CI 1.01-2.11), increased operative time (OR 1.01, 95 % CI 1.00-1.01), and hospital stay ≥5 days (OR 2.62, 95 % CI 1.55-4.43) were independent factors associated with perioperative adverse events.
  
  
  CONCLUSIONS
  The NSQIP-P database was used to describe surgical outcomes of posterior cranial fossa decompression in a US nationwide sample of 1459 children with Chiari type 1 malformation. The overall recorded adverse rate was low. Longer operative times and length of hospital stay ≥5 days during the index admission were associated with perioperative adverse events.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Vedantam
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Rory R
authors.initials: RR
authors.lastname: Mayer
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Staggers
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Harris
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.|Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Pan
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA. sklam@texaschildrens.org.|Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA. sklam@texaschildrens.org.
authors.forename: Sandi K
authors.initials: SK
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
keywords: Chiari malformation; NSQIP; Pediatric; Perioperative; Posterior fossa decompression; Readmission; Reoperation