Pituitary Surgery

Abstract

INTRODUCTION: Myelomeningocele (MMC) is the most commonly encountered neural tube defect in pediatric neurosurgery. Although the incidence of MMC has declined with aggressive educational campaigns highlighting the significance of folic acid supplementation in the prenatal period, this disease entity continues to be a serious health care problem. The prevalence of MMC in the United States is reported as high as 4.6 cases per 10,000 live births. The goal of this review is to highlight trends in the surgical treatment of MMC using a nation-wide database. METHODS: Clinical data was derived from the Nationwide Inpatient Sample (NIS) for the years 1993 through 2005. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the United States. Patients who underwent MMC repair were determined by using the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes for MMC repair (03.52). Data on the total number of discharges, length of stay (LOS), and charges (mean $) were available from 1993 through 2005. Data on the “national bill” were available from 1997 through 2005. RESULTS: A total of 7711 patients were identified. During the time period analyzed, the year 2002 had the lowest number of MMC cases (n = 411), whereas that number peaked in 2005 (n = 807). There also appeared to be a trend towards an increase in cases during the last two years analyzed. The average LOS decreased between 1993 and 1999 (from 20.8 to 11.9). Since then, however, there appeared to be an increasing trend of average LOS. The national bill (total national cost), excluding 1998, progressively increased. CONCLUSION: The increasing trends in myelomeningocele suggests the need for continued maternal and health care provider education and awareness of this entity.