PMID- 28059679 OWN - NLM STAT- MEDLINE DCOM- 20170316 LR - 20170316 IS - 1933-0715 (Electronic) IS - 1933-0707 (Linking) VI - 19 IP - 3 DP - 2017 Mar TI - Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics. PG - 361-371 LID - 10.3171/2016.10.PEDS16414 [doi] AB - 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. FAU - Kuo, Benjamin J AU - Kuo BJ AD - Division of Global Neurosurgery and Neuroscience and. AD - Global Health Institute, Duke University, Durham, North Carolina. AD - Duke-NUS Medical School, Singapore; FAU - Vissoci, Joao Ricardo N AU - Vissoci JR AD - Division of Global Neurosurgery and Neuroscience and. AD - Global Health Institute, Duke University, Durham, North Carolina. FAU - Egger, Joseph R AU - Egger JR AD - Global Health Institute, Duke University, Durham, North Carolina. FAU - Smith, Emily R AU - Smith ER AD - Division of Global Neurosurgery and Neuroscience and. AD - Global Health Institute, Duke University, Durham, North Carolina. FAU - Grant, Gerald A AU - Grant GA AD - Department of Neurosurgery, Stanford University, Stanford, California. FAU - Haglund, Michael M AU - Haglund MM AD - Division of Global Neurosurgery and Neuroscience and. AD - Global Health Institute, Duke University, Durham, North Carolina. AD - Departments of 4 Neurosurgery and. FAU - Rice, Henry E AU - Rice HE AD - Global Health Institute, Duke University, Durham, North Carolina. AD - Surgery, Duke University Medical Center, Durham, North Carolina; and. LA - eng PT - Journal Article DEP - 20170106 PL - United States TA - J Neurosurg Pediatr JT - Journal of neurosurgery. Pediatrics JID - 101463759 SB - IM MH - Adolescent MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Neurosurgical Procedures/mortality/standards/*trends MH - Pediatrics/standards/*trends MH - Postoperative Complications/mortality/*prevention & control MH - Quality Improvement/standards/*trends MH - Risk Factors MH - Treatment Outcome MH - United States/epidemiology OTO - NOTNLM OT - ACS = American College of Surgeons OT - AE = adverse event OT - AOR = adjusted OR OT - ASA = American Society of Anesthesiologists OT - CI = confidence interval OT - CPT = Current Procedural Terminology OT - IQR = interquartile range OT - NICU = neonatal intensive care unit OT - NSQIP = National Surgical Quality Improvement Program OT - NSQIP-Peds = NSQIP-Pediatrics OT - National Surgical Quality Improvement Program OT - OR = odds ratio OT - PICU = pediatric intensive care unit OT - QI = quality improvement OT - SSI = surgical site infection OT - WBC = white blood cell OT - quality improvement OT - risk-adjustment OT - surgical outcome OT - wRVU = work relative value unit EDAT- 2017/01/07 06:00 MHDA- 2017/03/17 06:00 CRDT- 2017/01/07 06:00 PHST- 2017/01/07 06:00 [pubmed] PHST- 2017/03/17 06:00 [medline] PHST- 2017/01/07 06:00 [entrez] AID - 10.3171/2016.10.PEDS16414 [doi] PST - ppublish SO - J Neurosurg Pediatr. 2017 Mar;19(3):361-371. doi: 10.3171/2016.10.PEDS16414. Epub 2017 Jan 6.