Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database

Abstract

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. We identified patients aged 0-18years 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 30days of the index procedure. 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 9.8years (median 10years). Median operative time was 141min (IQR 107-181min). 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 ≥5days, 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 ≥5days (OR 2.62, 95% CI 1.55-4.43) were independent factors associated with perioperative adverse events. 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 ≥5days during the index admission were associated with perioperative adverse events.