Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.
OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.
['Kuo|Benjamin J|BJ|', 'Vissoci|Joao Ricardo N|JR|', 'Egger|Joseph R|JR|', 'Smith|Emily R|ER|', 'Grant|Gerald A|GA|', 'Haglund|Michael M|MM|', 'Rice|Henry E|HE|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D019635:Neurosurgical Procedures D010372:Pediatrics D011183:Postoperative Complications D058996:Quality Improvement D012307:Risk Factors D016896:Treatment Outcome D014481:United States
quality improvement risk-adjustment ACS = American College of Surgeons AE = adverse event AOR = adjusted OR ASA = American Society of Anesthesiologists CI = confidence interval CPT = Current Procedural Terminology IQR = interquartile range NICU = neonatal intensive care unit NSQIP = National Surgical Quality Improvement Program NSQIP-Peds = NSQIP-Pediatrics National Surgical Quality Improvement Program OR = odds ratio PICU = pediatric intensive care unit QI = quality improvement SSI = surgical site infection WBC = white blood cell surgical outcome wRVU = work relative value unit