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McNevin K, Nicassio L, Rice-Townsend SE, Katz CB, Goldin A, Avansino J, Calkins CM, Durham MM, Page K, Ralls MW, Reeder RW, Rentea RM, Rollins MD, Saadai P, Wood RJ, van Leeuwen KD, Smith CA. Comparison of the PCPLC Database to NSQIP-P: A Patient Matched Comparison of Surgical Complications Following Repair of Anorectal Malformation. J Pediatr Surg 2024; 59:997-1002. [PMID: 38365475 DOI: 10.1016/j.jpedsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Anorectal malformations (ARM) are rare and heterogenous which creates a challenge in conducting research and offering recommendations for best practice. The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) was formed in 2016 to address this challenge and created a shared national data registry to collect information about pediatric colorectal patients. There has been no external validation of the data collected. We sought to evaluate the database by performing a patient matched analysis comparing 30-day outcomes identified in the PCPLC registry with the NSQIP-P database for patients undergoing surgical repair of ARM. METHODS Patients captured in the PCPLC database from 2016 to 2021 at institutions also participating in NSQIP-P who underwent ARM repair younger than 12 months old were reviewed for 30-day complications. These patients were matched to their NSQIP-P record using their hospital identification number, and records were compared for concordance in identified complications. RESULTS A total of 591 patient records met inclusion criteria in the PCPLC database. Of these, 180 patients were also reviewed by NSQIP-P. One hundred and fifty-six patient records had no complications recorded. Twenty-four patient records had a complication listed in one or both databases. There was a 91 % concordance rate between databases. When excluding complications not tracked in the PCPLC registry, this agreement improved to 93 %. CONCLUSION Including all patients evaluated for this subpopulation, a 91 % concordance rate was observed when comparing PCPLC collected complications to NSQIP-P. Future efforts can focus on further validating the data within the PCPLC for other patient populations. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kathryn McNevin
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Lauren Nicassio
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Samuel E Rice-Townsend
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Cindy B Katz
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Adam Goldin
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Jeffrey Avansino
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, 999 N 92 St Suite 320, Milwaukee, WI 53226, USA
| | - Megan M Durham
- Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Kent Page
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Matthew W Ralls
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, 1540 E Hospital Drive Level 4, Ann Arbor, MI 48109, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, USA
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Dr., Ste 3800 Salt Lake City, UT 84112, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, 2521 Stockton Blvd, 4th Floor Suite 4100, Sacramento, CA 95817, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
| | - Kathleen D van Leeuwen
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Caitlin A Smith
- Department of General Surgery, Seattle Children's Hospital, University of Washington, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
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Rajkumar S, Ikeda DS, Scanlon M, Shields M, Kestle JR, Plonsker J, Brandel M, Gonda DD, Levy M, Lucas DJ, Choi PM, Ravindra VM. Frequency and predictors of concurrent complications in multi-suture release for syndromic craniosynostosis. Childs Nerv Syst 2024; 40:153-162. [PMID: 37462812 PMCID: PMC10761552 DOI: 10.1007/s00381-023-06076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Understanding the complication profile of craniosynostosis surgery is important, yet little is known about complication co-occurrence in syndromic children after multi-suture craniosynostosis surgery. We examined concurrent perioperative complications and predictive factors in this population. METHODS In this retrospective cohort study, children with syndromic diagnoses and multi-suture involvement who underwent craniosynostosis surgery in 2012-2020 were identified from the National Surgical Quality Improvement Program-Pediatric database. The primary outcome was concurrent complications; factors associated with concurrent complications were identified. Correlations between complications and patient outcomes were assessed. RESULTS Among 5,848 children identified, 161 children (2.75%) had concurrent complications: 129 (2.21%) experienced two complications and 32 (0.55%) experienced ≥ 3. The most frequent complication was bleeding/transfusion (69.53%). The most common concurrent complications were transfusion/superficial infection (27.95%) and transfusion/deep incisional infection (13.04%) or transfusion/sepsis (13.04%). Two cardiac factors (major cardiac risk factors (odds ratio (OR) 3.50 [1.92-6.38]) and previous cardiac surgery (OR 4.87 [2.36-10.04])), two pulmonary factors (preoperative ventilator dependence (OR 3.27 [1.16-9.21]) and structural pulmonary/airway abnormalities (OR 2.89 [2.05-4.08])), and preoperative nutritional support (OR 4.05 [2.34-7.01]) were independently associated with concurrent complications. Children who received blood transfusion had higher odds of deep surgical site infection (OR 4.62 [1.08-19.73]; p = 0.04). CONCLUSIONS Our results indicate that several cardiac and pulmonary risk factors, along with preoperative nutritional support, were independently associated with concurrent complications but procedural factors were not. This information can help inform presurgical counseling and preoperative risk stratification in this population.
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Affiliation(s)
- Sujay Rajkumar
- Drexel University School of Medicine, Philadelphia, PA, USA
| | - Daniel S Ikeda
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Michaela Scanlon
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Margaret Shields
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - John R Kestle
- Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Jillian Plonsker
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Michael Brandel
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - David D Gonda
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA
| | - Michael Levy
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Pamela M Choi
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA.
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA.
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Junaid M, Slack-Smith L, Wong K, Hewitt T, Glasson E, Bourke J, Baynam G, Calache H, Leonard H. Hospitalizations from Birth to 28 Years in a Population Cohort of Individuals Born with Five Rare Craniofacial Anomalies in Western Australia. J Pediatr 2023; 259:113418. [PMID: 37030611 DOI: 10.1016/j.jpeds.2023.113418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE To describe trends, age-specific patterns, and factors influencing hospitalizations for 5 rare craniofacial anomalies (CFAs). METHODS Data on livebirths (1983-2010; n = 721 019) including rare CFA (craniofacial microsomia, mandibulofacial dysostosis, Pierre Robin sequence, Van der Woude syndrome, and frontonasal dysplasia), episodes of death, and demographic and perinatal factors were identified from the Western Australian Register of Developmental Anomalies, Death Registrations and Midwives Notification System. Information on incident craniofacial and noncraniofacial related admissions, length of hospital stay, and intensive care and emergency-related admissions were identified using principal diagnosis and procedural codes were extracted from the Hospital Morbidity Data Collection and linked to other data sources. Associations of hospitalizations by age groups as well as demographic and perinatal factors were expressed as incidence rate ratio (IRR). RESULTS The incident hospitalizations were 3 times as high for rare CFA (IRR 3.22-3.72) throughout childhood into adolescence than those without. Children with rare CFA had 3-4 times as many potentially preventable hospitalizations until 18 years of age than those without. Specifically, respiratory infections (IRR 2.13-2.35), ear infections (IRR 7.92-26.28), and oral health-related conditions contributed for most noncraniofacial admissions until the adolescence period. A greater incidence of noncraniofacial related hospitalizations was observed among Indigenous children, births with intrauterine growth restrictions, and families with high socioeconomic disadvantage. CONCLUSIONS Throughout childhood, individuals with rare CFA had greater hospital service use, specifically for potentially preventable conditions, than those without. These population-level findings can inform new preventive strategies and early disease management targeted toward reducing preventable hospitalizations.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Emma Glasson
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Gareth Baynam
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia; Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia; UWA Centre of Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
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Junaid M, Slack-Smith L, Wong K, Hewitt T, Bourke J, Baynam G, Calache H, Leonard H. Patterns, trends, and factors influencing hospitalizations for craniosynostosis in Western Australia. A population-based study. Eur J Pediatr 2023; 182:2379-2392. [PMID: 36899143 PMCID: PMC10175457 DOI: 10.1007/s00431-023-04922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
Understanding hospital service use among children with a diagnosis of craniosynostosis (CS) is important to improve services and outcomes. This study aimed to describe population-level trends, patterns, and factors influencing hospitalizations for craniosynostosis in Western Australia. Data on live births (1990-2010; n = 554,624) including craniosynostosis, episodes of death, demographic, and perinatal factors were identified from the midwives, birth defects, hospitalizations, and death datasets. Information on craniosynostosis and non-craniosynostosis-related admissions, cumulative length of hospital stay (cLoS), intensive care unit, and emergency department-related admissions were extracted from the hospitalization dataset and linked to other data sources. These associations were examined using negative binomial regression presented as annual percent change and associations of hospitalizations by age groups, demographic, and perinatal factors were expressed as incidence rate ratio (IRR). We found an increasing trend in incident hospitalizations but a marginal decline in cLoS for craniosynostosis over the observed study period. Perinatal conditions, feeding difficulties, nervous system anomalies, respiratory, and other infections contributed to majority of infant non-CS-related admissions.Respiratory infections accounted for about twice the number of admissions for individuals with CS (IRRs 1.94-2.34) across all observed age groups. Higher incidence of non-CS hospitalizations was observed among females, with associated anomalies, to families with highest socioeconomic disadvantage and living in remote areas of the state. Conclusion: Marginal reduction in the cLoS for CS-related admissions observed over the 21-year period are potentially indicative of improved peri-operative care. However, higher incidence of respiratory infection-related admissions for syndromic synostosis is concerning and requires investigation.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia. .,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
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Menon G, George M, Kumar P, Nair SM, Udayakumaran S, Krishnadas A, Subash P, Vasudevan A. Comparison of Perioperative Anesthetic Concerns in Simple and Complex Craniosynostosis Cases: A Retrospective Study. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0041-1740203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background We compared intraoperative and postoperative anesthetic parameters between simple (S-single suture) and complex (C-more than one suture) craniosynostosis cases.
Materials and Methods Data was collected from a retrospective review of anesthetic and postoperative records of patients who underwent craniosynostosis correction surgery between April 2014 and August 2019. Pearson’s chi-square and independent sample t-tests were used for analysis.
Results We analyzed data of 98 patients (S-simple craniosynostosis: 40 and C-complex craniosynostosis: 58). Statistically significant differences between simple and complex cases were seen only in the incidence of difficult airway, failed extubation, and requirement of postoperative ventilation. Massive blood loss (S: 23.21 mL/kg; C: 22.71 mL/kg) and difficult airway (S: 2.04%; C: 19.39%) were the most common intraoperative adverse events encountered. Metabolic abnormalities, hemodynamic instability, and hypothermia occurred in few patients. The most common postoperative issue was pyrexia (S: 15.31%; C: 17.35%). Anemia and coagulopathy needing transfusion of blood products and vitamin K injection were seen in a significant number of cases. Three nonsyndromic patients developed seizures.
Conclusion The incidence of difficult airway and failed extubation with postoperative ventilation is more frequent following surgery for complex craniosynostosis than simple craniosynostosis. Complications secondary to blood loss and airway issues were the primary cause of morbidity and mortality. A staged approach to surgical management resulted in decreased surgical blood loss among the children with complex craniosynostosis.
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Affiliation(s)
- Gokuldas Menon
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Mathew George
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Pawan Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Shalini M. Nair
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Suhas Udayakumaran
- Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Arjun Krishnadas
- Department of Cleft and Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Pramod Subash
- Department of Cleft and Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Anu Vasudevan
- Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Junaid M, Slack-Smith L, Wong K, Baynam G, Calache H, Hewitt T, Leonard H. Epidemiology of Hospital Admissions for Craniosynostosis in Australia: A Population-Based Study. Cleft Palate Craniofac J 2022; 60:569-576. [PMID: 35130078 DOI: 10.1177/10556656221074215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
To describe trends, age, and sex-specific patterns of population hospital admissions with a diagnosis of craniosynostosis (CS) in Australia. Population data for hospital separations (in-patient) from public and private hospitals (July 1996-June 2018) were obtained from the publicly available Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database. The outcome variables were hospital separation rates (HSR) (number of hospital separations divided by the estimated resident population [ERP] per year) and average length of stay (aLOS) (patient days divided by the number of hospital separations) with a diagnosis of CS. Trends in HSR and aLOS adjusted for age, sex, and type of CS were investigated by negative binomial regression presented as annual percent change (APC). In 8057 admissions identified, we observed no significant change in the annual trend for HSR for the 22-year period. However, a marginal annual decrease of 1.6% (95% CI: -0.7, -2.4) in the aLOS was identified for the same time period. HSR were higher for males, infants, and single suture synostosis. aLOS was 3.8 days (95% CI: 3.8, 3.9) per visit, longer for syndromic conditions. There was a minor reduction in the average length of hospital stay for CS over the 22-year period potentially indicative of improved care. Population-level information on hospitalisations for rare craniofacial conditions can inform research, clinical, and surgical practice.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Gareth Baynam
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Health, 569007Genetic Services of Western Australia, Perth, Western Australia, Australia
| | - Hanny Calache
- School of Health and Social Development, Faculty of Health, Deakin Health Economics, Institute of Health Transformation, 91844Deakin University, Geelong, Victoria, Australia.,Department of Dentistry and Oral Health, 56371La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Timothy Hewitt
- Department of Plastic Surgery, 60081Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Helen Leonard
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.,Faculty of Health and Medical Sciences, Centre of Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
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The Implications of Same-Day Discharge After Primary Unilateral Cleft Lip Repair: A National Surgical Quality Improvement Program-Based Study. J Craniofac Surg 2021; 33:436-439. [PMID: 34446672 DOI: 10.1097/scs.0000000000008103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Orofacial clefts are the most common craniofacial anomaly observed in the United States. Permitted by recent advancements in anesthesia and multimodal pain management, there has been a trend toward outpatient cleft lip repair to alleviate hospital burden and minimize healthcare costs. The purpose of this study was to compare complication rates between outpatient and inpatient cleft lip repair from large national samples as well as identify preoperative factors that predicted discharge status. METHODS The National Surgical Quality Improvement Program database for pediatrics was used to analyze 30-day outcomes for all patients undergoing cleft lip repair (CPT (current procedural terminology) code 40700) from 2012 to 2019. Complication rates were compared across 3 groups: same day discharge, next day discharge, and later discharge. Preoperative factors, including comorbidities and demographics, were analyzed to determine the impact of discharge date on complications as well as identify independent predictors of discharge timing and perioperative complications. RESULTS A total of 6689 patients underwent primary cleft lip repair, with 16.8% discharging on day of surgery, and 72.4% discharging 1 day after surgery. Complication rates were statistically equivalent between same day and next day discharge. Preoperative factors predicting complication and postoperative admission included age <6 months and weight less than ten pounds at the time of surgery. Patients discharged after more than 1 day in the hospital had higher rates of complications as well as more preoperative comorbidities. CONCLUSIONS Complication rates between same day and next day discharge are equivalent, suggesting that same day discharge is a safe option in select patients. Clinical judgment is critical in making these decisions.
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Junaid M, Slack-Smith L, Wong K, Baynam G, Calache H, Hewitt T, Leonard H. Description of Total Population Hospital Admissions for Treacher Collins Syndrome in Australia. Cleft Palate Craniofac J 2021; 59:1167-1175. [PMID: 34410170 DOI: 10.1177/10556656211036618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe patterns and demographic characteristics of total-population hospital admissions with a diagnosis of Treacher Collins syndrome (TCS) in Australia. DATA SOURCE Population summary data for inpatient hospitals admissions (public and private) with a principal diagnosis of TCS (ICD10-AM-Q87.04) were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database for a 11-year period (2002-2013). MAIN OUTCOME MEASURES The primary outcome was hospital separation rate (HSR), calculated by dividing the number of hospital separations by estimated resident population per year. Trends in HSR s adjusted for age and sex were investigated by negative binomial regression presented as annual percent change and the association of rates with age and sex was expressed as incidence rate ratio. RESULTS In 244 admissions identified, we observed an increase of 4.55% (95% confidence interval [CI] -1.78, 11.29) in HSR's over the 11-year period. Rates were higher during infancy (1.87 [95% CI 1.42, 2.42]), declining markedly with increasing age. The average length of hospital stay was 6.09 days (95% CI 5.78, 6.40) per episode, but longer for females and infants. CONCLUSIONS Findings indicate an increase in hospitalization rates, especially among infants and females which potentially relates to early airway intervention procedures possibly influenced by sex specific-disease severity and phenotypic variability of TCS. Awareness of the TCS phenotype and improved access to genetic testing may support more personalized and efficient care. Total-population administrative data offers a potential to better understand the health burden of rare craniofacial diseases.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Kingsley Wong
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Gareth Baynam
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.,569007Genetic Services of Western Australia, Perth, WA, Australia
| | - Hanny Calache
- Institute of Health Transformation, School of Health and Social Development, 91844Deakin University, Geelong, VIC, Australia.,56371La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | | | - Helen Leonard
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
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Craniosynostosis With Preoperative Iron Supplementation Exposure: A Retrospective Cohort Study Examining Preoperative Iron Supplementation and Transfusion Practice in a National Paediatric Craniofacial Centre. J Craniofac Surg 2021; 33:254-258. [PMID: 34411017 DOI: 10.1097/scs.0000000000008084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Blood loss and subsequent transfusion are key concerns in the surgical management of craniosynostosis, and have been associated with increased morbidity, requirement for intensive care admission and increased length of hospital stay. Patient blood management guidelines advocate treatment of anemia before elective surgical procedures where significant blood loss is anticipated. At present there is little evidence in the literature investigating the clinical value of this practice in pediatric craniofacial surgery. AIMS The authors examined the effect of preoperative oral iron supplementation on blood loss and transfusion rates in a national pediatric craniofacial unit. METHODS A total of 157 patients were included in a retrospective and prospective observational cohort study conducted between July 2011 and November 2016. Eighty-five (85) patients included in the preoperative iron supplementation group were prescribed oral ferrous fumarate before total cranial vault reconstruction, frontal-orbital advancement or extended strip cranial vault remodeling procedures. This cohort was retrospectively compared to seventy-two (72) consecutive patients who did not receive iron supplementation. RESULTS Calculated blood loss was 51.3 mL/kg in the intervention group, and 56.65 mL/kg in the control group. Transfusion rate and mean volumes for the intervention group were 85.9% and 25 mL/kg. The control group had transfusion rate of 86.1% with mean transfused volume of 24.7 mL/kg. These differences were not statistically significant. Intraoperative tranexamic acid was associated with significantly reduced transfusion volumes overall. CONCLUSIONS This study did not show a statistically significant benefit to preoperative iron supplementation. Secondary outcomes of this study showed a statistically significant difference in estimated versus calculated intraoperative blood loss. Further research in to specific iron supplementation protocols is indicated.
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Racial Disparities in the Surgical Management of Benign Craniomaxillofacial Bone Lesions. J Craniofac Surg 2021; 32:2631-2635. [PMID: 34238879 DOI: 10.1097/scs.0000000000007832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Racial disparities can influence surgical care in the United States. The purpose of this study was to determine if race and ethnicity were independent risk factors for adverse 30-day outcomes after surgical management of benign craniomaxillofacial bone tumors. METHODS This was a retrospective cohort study from 2012 to 2018 National Surgical Quality Improvement Program databases. Patients undergoing surgical removal of craniomaxillofacial benign lesions based on Current Procedural Terminology and International Classification of Diseases codes were included. Patients who had unrelated concurrent surgeries, or malignant, skull-based or soft tissue lesions were excluded. Primary outcomes were surgical complications and hospital length of stay (LOS). Univariate analyses were used with race as the independent variable to identify predictors of primary outcomes. Statistically significant factors were added to a multivariable logistic regression model. RESULTS This study included 372 patients. Postoperative complications were highest among Black patients, who had a 4-fold increase in minor complications (P = 0.023) and over a 6-fold increase in major complications (P = 0.008) compared to White patients. Black patients also had a mean increase of 2.3 days in LOS compared to White patients (P < 0.001). The multivariate regression model showed higher rates of major complications and longer LOS for Black patients (P = 0.003, P = 0.006, respectively). CONCLUSIONS Even when controlling for other variables, Black race was an independent risk factor for major complications and increased LOS. Further research should seek to identify the root cause of these findings in order to ensure safe and equitable surgery for all patients, regardless of race or ethnicity.
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Gadgil N, Rao G, Sawaya R, Yoshor D, Ruggieri L, Cormier N, Curry DJ, Whitehead WE, Aldave G, Bauer DF, McClugage S, Weiner HL. Pediatric neurosurgery at Texas Children's Hospital: the legacy of Dr. William R. Cheek. J Neurosurg Pediatr 2021; 28:86-92. [PMID: 33962381 DOI: 10.3171/2020.10.peds20807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/28/2020] [Indexed: 11/06/2022]
Abstract
Texas Children's Hospital opened its doors in 1954, and since that time the institution has remained dedicated to a three-part mission: patient care, education, and research. Dr. William R. Cheek developed an early interest in pediatric neurosurgery, which led to his efforts in building and developing a service at Texas Children's Hospital at a time when the field was just emerging. His work with other early pioneers in the field led to the establishment of organized societies, educational texts, and governing bodies that have led to significant advances in the field over the past 50 years.
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Affiliation(s)
- Nisha Gadgil
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Ganesh Rao
- 2Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Raymond Sawaya
- 2Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Daniel Yoshor
- 2Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Lucia Ruggieri
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Natalie Cormier
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Daniel J Curry
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - William E Whitehead
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Guillermo Aldave
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - David F Bauer
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Samuel McClugage
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
| | - Howard L Weiner
- 1Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine/Texas Children's Hospital; and
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Treatment of Osteomyelitic Bone Following Cranial Vault Reconstruction With Delayed Reimplantation of Sterilized Autologous Bone: A Novel Technique for Cranial Reconstruction in the Pediatric Patient. J Craniofac Surg 2021; 32:338-340. [PMID: 32969926 DOI: 10.1097/scs.0000000000007091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Craniosynostosis, a deformity of the skull caused by premature fusion of ≥1 cranial sutures, is treated surgically via endoscopic approaches or cranial vault remodeling. Postoperative infection is rare. Management of postoperative surgical site infections often involves culture-directed intravenous antibiotics and debridement, with removal of osteomyelitic bone and hardware in refractory cases. Removal of autologous bone in a pediatric patient presents a reconstructive challenge, as alloplastic options are not optimal in a growing child, especially in the setting of infection. Moreover, infants and small children have limited autologous bone options for reconstruction. We present our case of a young child who developed an infectious complication following cranial vault remodeling. The patient's demographic information, clinical presentation and postoperative course, radiologic features, surgical interventions, and treatment outcomes were reviewed. In our case, autologous osteomyelitic bone underwent tissue processing to eradicate the infection and complete skull reconstruction using the patient's own processed autologous bone was performed in a delayed fashion. The patient is now 1 year postoperative with no recurrence of infection. We present this case as a novel technique to eradicate infection in autologous bone, allowing for delayed autologous cranial reconstruction.
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Hagerty V, Hospedales E, Alayon A, Samuels S, Levene T, Spader H. Association of hospital characteristics and insurance type with quality outcomes for pediatric craniosynostosis patients. Clin Neurol Neurosurg 2021; 207:106742. [PMID: 34126452 DOI: 10.1016/j.clineuro.2021.106742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/29/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our study aimed to assess the association of insurance status and hospital ownership type with inpatient hospital outcomes among a nationally representative population of pediatric craniosynostosis neurosurgery patients. METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2006-2012 Kids Inpatient Database. Primary outcomes including length of stay, and favorable discharge disposition were assessed for all pediatric neurosurgery patients who underwent a neurosurgical procedure for craniosynostosis. RESULTS Pediatric neurosurgery patients with private insurance had a reduced length of stay of 0.75 days compared to patients insured by Medicaid. Compared to private, investor-owned hospitals, Government, non-federal, and private, not for profit hospital ownership types were associated with an increased length of stay greater than 1 day. CONCLUSIONS Our finding of increased LOS for craniosynostosis patients seen in other hospital ownership types compared to those seen in private, investor-owned hospitals is indicative of the possible role that financial incentives may play in influencing quality metrics. Although we observed a shortened LOS for privately-insured patients compared to patients insured by Medicaid, we found no difference in favorable discharge disposition based on insurance status. This suggests that patients with shorter LOS have similar outcomes and are likely not being prematurely discharged.
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Affiliation(s)
- Vivian Hagerty
- Florida Atlantic University, College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Emilio Hospedales
- Florida Atlantic University, College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Amaris Alayon
- Florida Atlantic University, College of Medicine, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, 4411 Sheridan Street, Hollywood, FL 33021, USA
| | - Tamar Levene
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave., Hollywood, FL 33021, USA
| | - Heather Spader
- Department of Neurosurgery, University of New Mexico, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
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Abstract
BACKGROUND The optimal age for cleft palate repair continues to be debated, with little discussion of surgical risk related to operative timing. This study of 3088 cleft palate patients analyzed the impact of surgical timing on perioperative and 30-day postoperative outcomes. METHODS Primary cleft palate repairs were identified in the National Surgical Quality Improvement Program database from 2012 to 2015. Data were combed for total postoperative complications, rates of readmission and reoperation, operating room time, and length of stay. Bivariate analyses were performed comparing 3-month periods from months 6 to 18, and months 0 to 5, 18 to 23, 24 to 29, and 30 to 59. RESULTS Despite a higher proportion of isolated soft palate closure, children operated on before 6 months had a higher complication rate than children at other ages (7.1 percent versus 3.2 percent; OR, 2.4; p = 0.04), and higher rates of both readmission (3.6 percent versus 1.4 percent; OR, 3.6; p = 0.02) and reoperation (2.4 percent versus 0.5 percent; OR, 4.7; p = 0.04). There were no differences in short-term outcomes for any other age group younger than 5 years, and no differences in hospital length of stay among any age groups. CONCLUSIONS The authors' findings suggest a relative contraindication to operation before 6 months. As there were no differences between any other age groups, long-term speech optimization should continue to be the primary consideration for operative planning. These findings improve the current rationale for palatoplasty timing, and can aid surgeons and parents in the surgical decision-making process. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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15
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Baş NS, Baş S. Craniometric Measurements and Surgical Outcomes in Trigonocephaly Patients Who Underwent Surgical Treatment. Cureus 2021; 13:e13676. [PMID: 33824827 PMCID: PMC8018725 DOI: 10.7759/cureus.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to discuss the results of craniometric measurements and surgical treatments in patients operated for isolated trigonocephaly (TC) in light of the current literature. Methods A total of 18 cases who underwent surgery for isolated TC were included in the study. Age, gender, family history, follow-up time, complications, duration of surgery, surgical blood loss, and amount of blood replacement in these patients were recorded. Craniometric measurements such as metopic angle (MA), cephalic index (CI), interparietal distance (IPD), intercoronal distance (ICD), and their ratio to each other were evaluated according to pre-and postoperative parameters. Photographs of the patients were taken before and after the operation. The Whitaker classification and Kampf "aesthetic outcome staging" were used in the evaluations. Results The mean MA values after the operation increased to reach above 147 degrees in all cases. The average CI did not change. ICD measurement averages increased significantly. The average IPD/ICD ratio decreased due to the increase in ICD and the enlargement of the anterior fossa after the operation. According to the Whitaker classification and Kampf “aesthetic outcome staging” scale, 17 of our cases were at stage I, rated as perfect, and one was at stage II, rated as good. Conclusion Surgery performed at the appropriate time for TC yields cosmetically satisfactory results. Since potential neurological and cognitive morbidities occur mostly in school-age patients, long-term follow-up of the cases is required. Performing craniometric measurements enables patients to be evaluated with objective and measurable numerical data.
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Affiliation(s)
- Nuri Serdar Baş
- Department of Neurosurgery, Bagcilar Education and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Serap Baş
- Department of Radiology, Gaziosmanpaşa Hospital, İstanbul Yeni Yüzyıl University, Istanbul, TUR
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Holle J, Finger T, Lugonja J, Schmidt F, Schaumann A, Gratopp A, Thomale UW, von Bernuth H, Schulz M. The Influence of Perioperative Antibiotic Prophylaxis on Wound Infection and on the Colonization of Wound Drains in Patients After Correction of Craniosynostosis. Front Pediatr 2021; 9:720074. [PMID: 34504818 PMCID: PMC8421650 DOI: 10.3389/fped.2021.720074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Evidence for the duration of perioperative antibiotic prophylaxis (PAP) after the correction of craniosynostosis in children is scarce. We evaluated the necessary duration of PAP to ensure a minimal rate of postoperative wound infections. Methods: In this monocentric, retrospective, and prospective pilot study, two PAP protocols were compared. From August 2017 to May 2018, treatment group 1 (TG 1) was treated using the standard PAP protocol with at least three doses of antibiotics. Between May 2018 and March 2019, a shortened PAP with a single-shot administration was given to treatment group 2 (TG 2a and b). Endpoints of this study were wound infection rate, colonization rate of wound drains, and the course of treatment reflected by clinical and laboratory data. Results: A cohort of 187 children underwent craniosynostosis correction: 167 were treated according to protocols--95 patients with at least three doses (TG 1) and 72 patients with a single-shot of cefuroxime (TG 2a). Baseline characteristics were similar for both groups. We could not detect significant differences, neither for wound infection rates (TG 1: 1.1%, TG 2a: 0.0%, p = 0.38) nor for colonization rates of wound drains (TG 1: 4.8%, TG 2a: 10.5%, p = 0.27). Conclusions: Single-shot PAP had no adverse effects on the wound infection rate or the colonization rate of the wound drains compared with prolonged perioperative antibiotic prophylaxis. As a result, single-shot preoperative PAP is now applied to the majority craniosynostosis patients undergoing surgical correction in our unit.
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Affiliation(s)
- Johannes Holle
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Finger
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Lugonja
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schmidt
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Schaumann
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Gratopp
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Horst von Bernuth
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Immunology, Labor Berlin GmbH, Berlin, Germany
| | - Matthias Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Assessment of Epidemiological Trends in Craniosynostosis: Limitations of the Current Classification System. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2597. [PMID: 32537323 PMCID: PMC7253271 DOI: 10.1097/gox.0000000000002597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/29/2019] [Indexed: 12/02/2022]
Abstract
Craniosynostosis affects 1 in 2,000 live births, which makes it one of the most common craniofacial abnormalities in the United States. Despite this fact, few national epidemiologic reports exist, although US and European studies have reported an increased incidence of metopic craniosynostosis. The aim of our study is to analyze the National Inpatient Sample (NIS) to support those conclusions.
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Abstract
BACKGROUND While there has been ample interest and literature published regarding craniosynostosis surgical technique, there are few reports on adverse hospital and health system outcomes. The purpose of this study was to describe rate of and risk factors for complications, and adverse outcomes following craniosynostosis reconstruction. METHODS This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database and identified all patients undergoing craniosynostosis repair from 2012 to 2016. Univariate logistic regression analysis was used to identify significant associations between preoperative risk factors and adverse outcomes. Multivariate logistic regression analysis was then used to identify independent risk factors and causes of prolonged operative times, transfusions, reoperation, prolonged length of hospital stays, and readmission. RESULTS There were 3924 patients included who underwent craniosynostosis repair, of whom 1732 underwent frontoorbital advancement and 2192 underwent cranial vault remodeling. Transfusion was the most common NSQIP reportable outcome, occurring for 66.5% of all patients. The incidence of reoperation was 2.4% and readmission was 3.0%. CONCLUSION This study provides a large descriptive analysis of craniosynostosis repair throughout the United States. Largely nonmodifiable patient risk factors lead to worse health system metrics, with young age, gastrointestinal comorbidities, American Society of Anesthesiologist scores of 3 and greater, reoperation, and a prolonged length of stay as independent risk factors for readmission. This analysis can be used to identify the standard of practice in synostosis care and enhance the implementation of ancillary care services to provide safe and cost-effective care for patients undergoing craniosynostosis repair.
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Bhargava S, Sharma M, Dietz N, Dettori J, Ugiliweneza B, Nuno M, Boakye M, Drazin D. Demographics and Outcomes of Spine Surgery in Octogenarians and Nonagenarians: A Comparison of the National Inpatient Sample, MarketScan and National Surgical Quality Improvement Program Databases. Cureus 2019; 11:e6195. [PMID: 31886087 PMCID: PMC6922298 DOI: 10.7759/cureus.6195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Despite the increasing use of national databases to conduct spine research, questions remain regarding their study validity and consistency. This study tested for similarity and inter-database reliability in reported measures between three commonly used national databases. Methods International Classification of Diseases, 9th edition (ICD-9) codes were used to identify elderly (80-100 years) who underwent spine surgery patients in Truven Health Analytics MarketScan® claims database, National (Nationwide) Inpatient Sample (NIS) discharge database and National Surgical Quality Improvement Program (NSQIP) database (2006-2016). Patient baseline characteristics, comorbid status, insurance enrollment, and outcomes were queried and compared. Results We analyzed 15,105 MarketScan, 40,854 NIS, and 7682 NSQIP patients between ages 80 to 100 years (median, 82 years) who underwent spine surgeries during the study period. A majority of patients in both MarketScan and NIS were insured by Medicare (97% vs. 94%). Patients in MarketScan had lower comorbidity scores (comorbidity, 0-2) compared to those in NIS and NSQIP databases. The most common diagnosis was spinal stenosis in MarketScan (54.4%), NIS (54.6%), and NSQIP databases (65.2%). Fusion was the most common procedure performed in MarketScan (48.9%) and NIS databases (46.2%), whereas decompression (laminectomy/laminotomy) was the most common procedure in the NSQIP database (51.84%). In-hospital complications (any) were 6.5% in the MarketScan cohort, 5.3% in the NIS, and 2.02% in the NSQIP cohort. In terms of 30-day complications (any), the MarketScan database reported higher complications rate (12.7%) compared to the NSQIP database (5.08%). In-hospital mortality was slightly higher in the NIS database (0.32%) compared to MarketScan (0.21%) and NSQIP database (0.2%). MarketScan and NIS databases showed an increased risk of complications with increasing age, whereas NIS and NSQIP showed increasing complications with a higher number of comorbidities. Male gender had higher complication at 30-day post-discharge using MarketScan and NSQIP database. Conclusions Patients in the NSQIP and NIS database have more comorbidities; patients in the MarketScan database had the highest number of perioperative and 30-day post-discharge complications with the highest number of fusion procedures performed. Patients in the NSQIP database had the lowest number of fusion procedures and complication rates. As databases gain popularity in spine surgery, clinicians and reviewers should be cautious in generalizing results to whole populations and pay close attention to the population being represented by the data from which the statistical significance was derived.
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Affiliation(s)
| | - Mayur Sharma
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Nicholas Dietz
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Joseph Dettori
- Evidence Practice Center, Spectrum Research, Tacoma, USA
| | | | - Miriam Nuno
- Statistics, University of California, Davis, USA
| | - Maxwell Boakye
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Doniel Drazin
- Medicine, Pacific Northwest University of Health Sciences, Yakima, USA
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National Databases in Pediatric Orthopaedic Surgery: A Comparison of Demographics, Procedures, and Outcomes. J Pediatr Orthop 2019; 39:e636-e640. [PMID: 31393308 DOI: 10.1097/bpo.0000000000001204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Large national databases have been increasingly used in recent years to determine the rate of adverse events and identify factors associated with altered surgical outcomes. This can be especially useful to evaluate rare events such as 30-day mortality. Despite differences between national pediatric databases, there have been no comparison studies in the pediatric orthopaedic population. METHODS The Healthcare Cost and Utilization Project's Kids' Inpatient Database (KID) along with the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP Pediatric) databases were queried to identify common pediatric orthopaedic procedures for humeral fractures, scoliosis, slipped capital femoral epiphysis, and femoral fractures during a single year. Clinical characteristics and complications in the 2 databases were compared using Student t test, χ, or Fisher' exact test. RESULTS In total, 26,978 patients in the KID and 5186 patients in the NSQIP Pediatric databases were identified. Large differences were observed between the databases in identical procedure categories with respect to age, race, sex, and length of stay. Regardless of procedure, NSQIP Pediatric had statistically higher reported rates of cumulative complications. Surgical site infections and sepsis were consistently observed to be at least twice as common in the NSQIP Pediatric database in comparison to the KID. Overall, complication rates ranged from <1% in humeral fractures to >100% in neuromuscular scoliosis. CONCLUSIONS Clinically and statistically significant differences exist between the KID and NSQIP Pediatric databases. Clinicians and researchers who utilize large databases must understand the differences in data import, quality control, and population sampling in order to provide adequate representation of the population as a whole. LEVEL OF EVIDENCE Level III, prognostic study.
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Perioperative Management and Factors Associated With Transfusion in Cranial Vault Reconstruction. J Craniofac Surg 2019; 30:2014-2017. [PMID: 31449228 DOI: 10.1097/scs.0000000000005666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bleeding is the most common adverse event in patients undergoing cranial vault reconstruction. The authors compare the transfusion rates against a national sample to determine whether the patients experience lower transfusion rates. METHODS The authors queried the Pediatric National Surgical Quality Improvement Program (Peds-NSQIP) for patients who underwent cranial vault reconstruction (CPT 61559) and compared them to patients who underwent cranial vault reconstruction for sagittal craniosynostosis at Children's Hospital and Medical Center (CHMC) in Omaha, Nebraska. Patients over the age of 24 months were excluded. Binary logistic regression analysis was performed using IBM-SPSS v24.0 to determine factors associated with transfusion at CHMC. RESULTS Patient demographics, preoperative hematocrit and platelet counts, readmission rates, and reoperation rates did not differ between CHMC (N = 54) and Peds-NSQIP (N = 1320) cohorts. Patients in the CHMC cohort had shorter preincision anesthesia times (47 versus 80 minutes, P < 0.001), shorter operative times (108 versus 175 minutes, P < 0.001), lower transfusion rates (50% versus 73%, P < 0.001), and smaller mean transfusion volumes (16 versus 33 mL/kg, P < 0.001); however mean length of stay was longer (4.1 versus 3.6 days, P < 0.001). Factors independently associated with transfusion at CHMC included preoperative hematocrit (odds ratio [OR] 0.423, P = 0.002), administration of an antifibrinolytic agent (OR 0.004, P = 0.001) and temperature at the time of incision (OR 0.020, P = 0.043). CONCLUSION Patients at CHMC require less transfused blood and experience low transfusion rates. Preoperative hematocrit, administration of antifibrinolytic agents, and temperature at the time of incision are all modifiable factors associated with perioperative transfusion.
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Topical Vancomycin for Surgical Prophylaxis in Pediatric Craniofacial Surgeries. J Craniofac Surg 2019; 30:2163-2167. [PMID: 31261326 DOI: 10.1097/scs.0000000000005708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Topical vancomycin has been demonstrated to be safe and effective for reducing surgical site infections (SSIs) following spine surgery in both adults and children, however, there are no studies of its efficacy in reducing SSIs in craniofacial surgery. The SSIs are one of the most common complications following craniofacial surgery. The complexity of craniofacial procedures, use of grafts and implants, long operative durations and larger surgical wounds all contribute to the heightened risk of SSIs in pediatric craniofacial cases. A retrospective review of all open and endoscopic pediatric craniofacial procedures performed between May 2014 and December 2017 at a single children's hospital was conducted to examine SSI rates between patients receiving topical vancomycin and a historical control group. The treatment group received topical vancomycin irrigation before wound closure. An ad-hoc cost analysis was performed to determine the cost-savings associated with topical vancomycin use. A total of 132 craniofacial procedures were performed during the study period, with 50 cases in the control group and 82 cases in the vancomycin group. Overall, SSI rate was 3.03%. Use of topical vancomycin irrigation led to a significant reduction in SSIs (4/50 SSI or 8.0% in control group vs 0/82 or 0% in vancomycin group, P = 0.04). No adverse events were observed with topical vancomycin use. The potential cost-savings associated with the use of topical vancomycin as SSI prophylaxis in this study was $102,152. Addition of topical vancomycin irrigation as routine surgical infection prophylaxis can be an effective and low-cost method for reducing SSI in pediatric craniofacial surgery.
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Dasenbrock HH, Smith TR, Robinson S. Preoperative laboratory testing before pediatric neurosurgery: an NSQIP-Pediatrics analysis. J Neurosurg Pediatr 2019; 24:92-103. [PMID: 30978681 DOI: 10.3171/2018.12.peds18441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 12/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate clinical predictors of abnormal preoperative laboratory values in pediatric neurosurgical patients. METHODS Data obtained in children who underwent a neurosurgical operation were extracted from the prospective National Surgical Quality Improvement Program-Pediatrics (NSQIP-P, 2012-2013) registry. Multivariable logistic regression evaluated predictors of preoperative laboratory values that might require further evaluation (white blood cell count < 2000/μl, hematocrit < 24%, platelet count < 100,000/μl, international normalized ratio > 1.4, or partial thromboplastin time > 45 seconds) or a preoperative transfusion (within 48 hours prior to surgery). Variables screened included patient demographics; American Society of Anesthesiologists (ASA) physical designation classification; comorbidities; recent steroid use, chemotherapy, or radiation therapy; and admission type. Predictive score validation was performed using the NSQIP-P 2014 data. RESULTS Of the 6556 patients aged greater than 2 years, 68.9% (n = 5089) underwent laboratory testing, but only 1.9% (n = 125) had a critical laboratory value. Predictors of a laboratory abnormality were ASA class III-V; diabetes mellitus; hematological, hypothrombotic, or oncological comorbidities; nutritional support; recent chemotherapy; systemic inflammatory response syndrome; and a nonelective hospital admission. These 9 variables were used to create a predictive score, with a single point assigned for each predictor. The prevalence of critical values in the validation population (NSQIP-P 2014) of patients greater than 2 years of age was 0.3% with a score of 0, 1.0% in those with a score of 1, 1.6% in those with a score of 2, and 6.2% in those with a score ≥ 3. Higher score was predictive of a critical value (OR 2.33, 95% CI 1.91-2.83, p < 0.001, C-statistic 0.76) and with the requirement of a perioperative transfusion (intraoperatively or within 72 hours postoperatively; OR 1.42, 95% CI 1.22-1.67, p < 0.001) in the validation population. Moreover, when the same score was applied to children aged 2 years or younger, a greater score was predictive of a critical value (OR 2.47, 95% CI 2.15-2.84, p < 0.001, C-statistic 0.76). CONCLUSIONS Critical laboratory values in pediatric neurosurgical patients are largely predicted by clinical characteristics, and abnormal preoperative laboratory results are rare in patients older than 2 years of age without comorbidities who are undergoing elective surgery. The NSQIP-P critical preoperative laboratory value scale is proposed to indicate patients with the highest odds of an abnormal value. The scale can assist with triaging preoperative testing based on the surgical risk, as determined by the treating surgeon and anesthesiologist.
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Affiliation(s)
- Hormuzdiyar H Dasenbrock
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shenandoah Robinson
- 1Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
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Hospital Volume Improves Primary, Revision, and Delayed Cleft Palate Repair. J Craniofac Surg 2019; 30:1201-1205. [DOI: 10.1097/scs.0000000000005270] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bokshan SL, Mehta S, DeFroda SF, Owens BD. What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients. Arthroscopy 2019; 35:1576-1581. [PMID: 30926191 DOI: 10.1016/j.arthro.2018.12.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the individual costs associated with anterior crucial ligament reconstruction (ACLR), accounting for patient demographics, perioperative decision making, and location of the surgical procedure (hospital vs ambulatory surgery center), utilizing a cost-minimization analysis in a large national database. METHODS Univariate analysis and multiple linear regression were performed to determine which patient and surgical variables were the largest cost drivers for ACLR in the United States according to the State Ambulatory Surgery and Services Database. RESULTS The average cost for ACLR (n = 14,713) was $24,707 (standard deviation, $15,644). When patient variables were considered, younger age (P < .001), male sex (P < .001), Hispanic ethnicity (P < .001), number of chronic medical conditions (P < .001), Medicare insurance (P < .001), and quartile of household income (P < .001) were all associated with higher costs after ACLR. For operative variables, time spent in the operating room (P < .001), meniscal repair (P < .001), and use of general anesthesia alone (P < .001) were all associated with higher costs for ACLR. There was no significant difference between cost of surgery performed at a private surgery center and cost at a hospital-owned center. In the multivariate regression, the 3 variables with the greatest influence on cost of ACLR were use of isolated general anesthesia (associated with an increase of $2,049), Hispanic ethnicity ($1,828), and >1 chronic medical condition ($1,749). Male sex, time in operating room, and older age also significantly increased ACLR cost. CONCLUSIONS The greatest contributor to cost of ACLR was the use of general anesthesia alone. Time spent in the operating room increased ACLR cost by $108 per minute. Patient factors included greater age, male sex, Hispanic ethnicity, number of chronic medical conditions, Medicare insurance, and annual income. Meniscal repair and regional nerve block did not significantly affect cost as determined by multivariate regression.
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Affiliation(s)
- Steven L Bokshan
- Department of Orthopaedic Surgery, Brown University, Alpert School of Medicine, Providence, Rhode Island, U.S.A
| | - Shayna Mehta
- Department of Orthopaedic Surgery, Brown University, Alpert School of Medicine, Providence, Rhode Island, U.S.A
| | - Steven F DeFroda
- Department of Orthopaedic Surgery, Brown University, Alpert School of Medicine, Providence, Rhode Island, U.S.A
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Alpert School of Medicine, Providence, Rhode Island, U.S.A.; Department of Sports Medicine, Brown University, Alpert School of Medicine, Providence, Rhode Island, U.S.A..
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Corkum KS, Baumann LM, Lautz TB. Complication Rates for Pediatric Hepatectomy and Nephrectomy: A Comparison of NSQIP-P, PHIS, and KID. J Surg Res 2019; 240:182-190. [PMID: 30954859 DOI: 10.1016/j.jss.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 01/22/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Three large national data sets are commonly used to assess operative outcomes in pediatric surgery; National Surgical Quality Improvement Program Pediatric (NSQIP-P), Pediatric Health Information System (PHIS), and Kids' Inpatient Data set (KID). Hepatectomy and nephrectomy are rare pediatric surgical procedures, which may benefit from large administrative data sets for the assessment of short-term complications. MATERIALS AND METHODS A retrospective review of NSQIP-P (2012-2015), KID (2012), and PHIS (2012-2015) was performed for hepatectomy or nephrectomy cases for children aged 0 to 18 y. Thirty-day perioperative outcomes were collected, analyzed, and compared across data sets and surgical cohorts. RESULTS Rates of surgical site infection, wound dehiscence, central line infection, sepsis, and venous thromboembolism were similar across NSQIP-P, PHIS, and KID in both cohorts. Rates of pneumonia and renal insufficiency were higher in PHIS and KID versus NSQIP-P in both cohorts. Blood transfusions in NSQIP-P were higher than PHIS and KID in the hepatectomy group (50.9% versus 43.0% versus 32.4%, P < 0.001), but similar across data sets in the nephrectomy cohorts (12.0% versus 14.0% versus 13.0%, P = 0.15). PHIS reported higher readmission rates than NSQIP-P for both the hepatectomy (56.5% versus 17.9%, P < 0.001) and nephrectomy (32.6% versus 7.6%,P < 0.001) cohorts. Thirty-day mortality rates were similar between NSQIP-P and PHIS, but higher in KID as compared with NSQIP-P for hepatectomy (6.4% versus 0.4%, P < 0.001) and nephrectomy (2.0% versus 0.3%, P < 0.001) cases. CONCLUSIONS Administrative data sets provide large sample sizes for the study of low-volume procedures in children, but there are significant variations in the reported rates of perioperative outcomes between NSQIP-P, PHIS, and KID. Therefore, surgical outcomes should be interpreted within the context of the strengths and limitations of each data set.
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Affiliation(s)
- Kristine S Corkum
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lauren M Baumann
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Timothy B Lautz
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Augustine HFM, Hu J, Najarali Z, McRae M. Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research. Plast Surg (Oakv) 2019; 27:54-65. [PMID: 30854363 DOI: 10.1177/2292550318800499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The National Surgical Quality Improvement Program (NSQIP) is a robust, high-quality surgical outcomes database that measures risk-adjusted 30-day outcomes of surgical interventions. The purpose of this scoping review is to describe how the NSQIP is being used in plastic surgery research. Methods A comprehensive electronic literature search was completed in PubMed, Embase, MEDLINE, and CINAHL. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. Articles were included if they utilized NSQIP data to conduct research in a domain of plastic surgery or analyzed surgical procedures completed by plastic surgeons. Extracted information included the domain of plastic surgery, country of origin, journal, and year of publication. Results A total of 106 articles met the inclusion criteria. The most common domain of plastic surgery was breast reconstruction representing 35% of the articles. Of the 106 articles, 95% were published within the last 5 years. The Plastic and Reconstructive Surgery journal published most of the (59%) NSQIP-related articles. All of the studies were retrospective. Of note, there were no articles on burns and only one study on trauma as the domain of plastic surgery. Conclusion This scoping review describes how NSQIP data are being used to analyze plastic surgery interventions and outcomes in order to guide quality improvement in 106 articles. It demonstrates the utility of NSQIP in the literature, however also identifies some limitations of the program as it applies to plastic surgery.
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Affiliation(s)
- Haley F M Augustine
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jiayi Hu
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Najarali
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew McRae
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
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Goobie S, Zurakowski D, Isaac K, Taicher B, Fernandez P, Derderian C, Hetmaniuk M, Stricker P, Abruzzese C, Apuya J, Beethe A, Benzon H, Binstock W, Brzenski A, Budac S, Busso V, Chhabada S, Chiao F, Cladis F, Claypool D, Collins M, Dabek R, Dalesio N, Falconl R, Fernandez A, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie SM, Gosman A, Grap S, Gries H, Griffin A, Haberkern C, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Kars M, Kowalczyk-Derderian C, Kugler J, Labovsky K, Lakheeram I, Lee A, Martinez JL, Masel B, Medellin E, Meier P, Levy HM, Muhly WT, Muldowney B, Nelson J, Nicholson J, Nguyen KP, Nguyen T, Olutuye O, Owens-Stubblefield M, Parekh UR, Petersen T, Pohl V, Post J, Poteet-Schwartz K, Prozesky J, Reddy S, Reid R, Ricketts K, Rubens D, Ryan L, Skitt R, Soneru C, Spitznagel R, Stricker P, Singh D, Singhal NR, Sorial E, Staudt S, Stubbeman B, Sung W, Syed T, Szmuk P, Taicher BM, Thompson D, Tretault L, Ungar-Kastner G, Watts R, Wieser J, Wong K, Zamora L. Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group. Br J Anaesth 2019; 122:215-223. [DOI: 10.1016/j.bja.2018.10.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022] Open
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Impact of Cardiac Risk Factors on Complications Following Cranial Vault Remodeling: Analysis of the 2012 to 2016 National Safety Quality Improvement Program-Pediatric Database. J Craniofac Surg 2019; 30:442-447. [PMID: 30615003 DOI: 10.1097/scs.0000000000005114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Congenital cardiac malformations have been reported in 8% of patients with craniosynostosis undergoing cranial vault remodeling (CVR), but associations with surgical outcomes are unknown. This study evaluated postoperative complications in patients who underwent CVR for craniosynostosis with or without cardiac risk factors (CRF) using the National Safety Quality Improvement Program-Pediatric (NSQIP-P) database. NSQIP-P database was queried for patients <2 years with craniosynostosis who underwent CVR from 2012 to 2016 based on diagnosis and procedure codes. The primary outcome was a composite of available NSQIP-P complications. Analysis compared patients with craniosynostosis based on the presence or absence of CRF. Univariate and multiple logistic regression identified risk factors associated with postoperative complications. A total of 3293 patients met inclusion criteria (8% with CRF). Two-thirds of patients experienced at least 1 complication, though patients with CRF experienced a greater proportion (74% vs 66%, P = 0.001). Univariate analysis identified associations between post-operative complications and age, ASA class, supplemental oxygen, neuromuscular disorders, preoperative nutritional supplementation, interventricular hemorrhage, and CRF. On multivariate regression, only older age (OR 1.17, 95% CI 1.01-1.36) and longer operative duration (OR 1.01, 95% CI 1.01-1.01) were associated with greater odds of postoperative complications. The most common complication in patients with craniosynostosis who undergo CVR is bleeding requiring transfusion. Older age and longer operative duration were associated with postoperative complications. Although patients with CRF have more postoperative complications, CRF was not a risk factor on adjusted analysis.
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Oravec CS, Motiwala M, Reed K, Jones TL, Klimo P. Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis. Pediatr Neurosurg 2019; 54:85-97. [PMID: 30799390 DOI: 10.1159/000495790] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We sought to describe pediatric "big data" publications since 2000, their statistical output, and clinical implications. METHODS We searched 4 major North American neurosurgical journals for articles utilizing non-neurosurgery-specific databases for clinical pediatric neurosurgery research. Articles were analyzed for descriptive and statistical information. We analyzed effect sizes (ESs), confidence intervals (CIs), and p values for clinical relevance. A bibliometric analysis was performed using several key citation metrics. RESULTS We identified 74 articles, which constituted 1.7% of all pediatric articles (n = 4,436) published, with an exponential increase after 2013 (53/74, 72%). The Healthcare Cost and Utilization Project (HCUP) databases were most frequently utilized (n = 33); hydrocephalus (n = 19) was the most common study topic. The statistical output (n = 49 studies with 464 ESs, 456 CIs, and 389 p values) demonstrated that the majority of the ESs (253/464, 55%) were categorized as small; half or more of the CI spread (CIS) values and p values were high (274/456, 60%) and very strong (195/389, 50%), respectively. Associations with a combination of medium-to-large ESs (i.e., magnitude of difference), medium-to-high CISs (i.e., precision), and strong-to-very strong p values comprised only 20% (75/381) of the reported ESs. The total number of citations for the 74 articles was 1,115 (range per article, 0-129), with the median number of citations per article being 8.5. Four studies had > 50 citations, and 2 of them had > 100 citations. The calculated h-index was 16, h-core citations were 718, the e-index was 21.5, and the Google i10-index was 34. CONCLUSIONS There has been a dramatic increase in the use of "big data" in the pediatric neurosurgical literature. Reported associations that may, as a group, be of greatest interest to practitioners represented only 20% of the total output from these publications. Citations were weighted towards a few highly cited publications.
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Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA, .,Semmes Murphey, Memphis, Tennessee, USA, .,Le Bonheur Children's Hospital, Memphis, Tennessee, USA,
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National Longitudinal Comparison of Patients Undergoing Surgical Management of Craniosynostosis. J Craniofac Surg 2018; 29:1755-1759. [DOI: 10.1097/scs.0000000000004775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gadgil N, Pan IW, Babalola S, Lam S. Evaluating the National Surgical Quality Improvement Program-Pediatric Surgical Risk Calculator for Pediatric Craniosynostosis Surgery. J Craniofac Surg 2018; 29:1546-1550. [PMID: 29877982 DOI: 10.1097/scs.0000000000004654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The American College of Surgeons' National Surgical Quality Improvement Program-Pediatric (NSQIP-P) risk calculator was developed based on national data. There have been no studies assessing the risk calculator's performance in pediatric neurosurgery. The authors aimed to evaluate the predictions from the risk calculator compared to our single institution experience in craniosynostosis surgery. METHODS Outcomes from craniosynostosis surgeries performed between 2012 and 2016 at our academic pediatric hospital were evaluated using the NSQIP-P risk calculator. Descriptive statistics were performed comparing predicted 30-day postoperative events and clinically observed outcomes. The performance of the calculator was evaluated using the Brier score and receiver operating characteristic curve (ROC). RESULTS A total of 202 craniosynostosis surgeries were included. Median age was 0.74 years (range 0.15-6.32); 66% were males. Blood transfusion occurred in 162/202 patients (80%). The following clinical characteristics were statistically correlated with surgical complications: American Society of Anesthesiologists physical status classification >1 (P < 0.001), central nervous system abnormality (P < 0.001), syndromic craniosynostosis (P = 0.001), and redo operations (P = 0.002). Postoperative events occurred in <3%, including hardware breakage, tracheal-cartilaginous sleeve associated with critical airway, and surgical site infection. The calculator performed well in predicting any complication (Brier = 0.067, ROC = 73.9%), and for pneumonia (Brier = 0.0049, ROC 99%). The calculator predicted a low rate of cardiac complications, venous thromboembolism, renal failure, reintubation, and death; the observed rate of these complications was 0. CONCLUSIONS The risk calculator demonstrated reasonable ability to predict the low number of perioperative complications in patients undergoing craniosynostosis surgery with a composite complications outcome. Efforts to improve the calculator may include further stratification based on procedure-specific risk factors.
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Affiliation(s)
- Nisha Gadgil
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Predictors of Postoperative Complications of Craniosynostosis Repair in the National Inpatient Sample. Ann Plast Surg 2018; 80:S261-S266. [DOI: 10.1097/sap.0000000000001383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anderson KT, Appelbaum R, Bartz-Kurycki MA, Tsao K, Browne M. Advances in perioperative quality and safety. Semin Pediatr Surg 2018; 27:92-101. [PMID: 29548358 DOI: 10.1053/j.sempedsurg.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
For decades, safe surgery focused on intraoperative technique and decision-making. The traditional hierarchy placed the surgeon as the leader with ultimate authority and responsibility. Despite the advances in surgical technique and equipment, too many patients have suffered unnecessary complications and suboptimal care. Today, we understand that the conduct of safe and effective surgery requires evidence-based decision-making, multifaceted treatment approaches to prevent complications, and effective communication in and out of the operating room. In this manuscript, we describe three significant advances in quality and safety that have changed the approach to surgical care: the National Surgical Quality Improvement Program, evidence-based bundled prevention of surgical site infections, and the Surgical Safety Checklist.
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Affiliation(s)
- Kathryn T Anderson
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rachel Appelbaum
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Marisa A Bartz-Kurycki
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - KuoJen Tsao
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marybeth Browne
- USF Morsani College of Medicine, Division of Pediatric Surgical Specialties, Lehigh Valley Children's Hospital, Department of Surgery, Lehigh Valley Health Network, 1210 S Cedar Crest Blvd, Allentown, PA 18103-6241, USA.
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Anania P, Pacetti M, Ravegnani M, Pavanello M, Piatelli G, Consales A. Iatrogenic Pseudoaneurysm of Superficial Temporal Artery After Surgery for Scaphocephaly: Case Report and Review of Literature. World Neurosurg 2018; 111:60-62. [DOI: 10.1016/j.wneu.2017.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
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Vedantam A, Pan IW, Staggers KA, Lam SK. Thirty-day outcomes in pediatric epilepsy surgery. Childs Nerv Syst 2018; 34:487-494. [PMID: 29086075 DOI: 10.1007/s00381-017-3639-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to use the multicenter American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) to evaluate and identify risk factors for 30-day adverse events in children undergoing epilepsy surgery. METHODS Using the 2015 NSQIP-P database, we identified children (age 0-18 years) undergoing pediatric epilepsy surgery and analyzed NSQIP-defined complications, unplanned reoperations, and unplanned readmissions. Multivariable logistic regression analysis was performed using perioperative data to identify risk factors for adverse events within 30 days of the index procedure. RESULTS Two hundred eight pediatric patients undergoing epilepsy surgery were identified for the year 2015 in the NSQIP-P database. The majority of patients were male (51.8%) and white (72.9%). The median age was 10 years. Neurological and neuromuscular comorbidities were seen in 62.5% of patients. Surgical blood loss and transfusion was the most common overall NSQIP-defined event (15.7%) and was reported in 40% with hemispherectomy. Nineteen patients (6.8%) had an unplanned reoperation and 20 patients (7.1%) had an unplanned readmission. Multivariable logistic regression analysis showed that African American patients (OR 3.26, 95% CI 1.29-8.21, p = 0.01) and hemispherectomy (OR 3.05, 95% CI 1.4-6.65, p = 0.01) were independently associated with NSQIP-defined complications. Patients undergoing hemispherectomy (OR 4.11, 95% CI 1.48-11.42, p = 0.01) were also at significantly higher risk of unplanned readmission after pediatric epilepsy surgery. CONCLUSIONS Data from the 2015 NSQIP-P database showed that hemispherectomy was significantly associated with higher perioperative events in children undergoing epilepsy surgery. Quality improvement initiatives for hemispherectomy should target surgical blood loss and wound-related complications. Racial disparities in access to cranial pediatric epilepsy surgery and perioperative complications were also highlighted in the present study.
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Affiliation(s)
- Aditya Vedantam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - I-Wen Pan
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Kristen A Staggers
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
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Bruce WJ, Chang V, Joyce CJ, Cobb AN, Maduekwe UI, Patel PA. Age at Time of Craniosynostosis Repair Predicts Increased Complication Rate. Cleft Palate Craniofac J 2017; 55:649-654. [PMID: 29665342 DOI: 10.1177/1055665617725215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study uses administrative data to assess the optimal timing for surgical repair of craniosynostosis and to identify factors associated with risk of perioperative complications. DESIGN Statistical analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (2006, 2009, 2012). SETTING KID-participating hospitals in 44 states. PATIENTS Children 0 to 3 years of age with ICD-9 codes for surgical correction of craniosynostosis (756 and 0124, 0125, 0201, 0203, 0204, or 0206). MAIN OUTCOME MEASURE Age-based cohorts were assessed for perioperative complications. We performed a multivariable analysis to determine characteristics associated with increased risk of complications. RESULTS 21 million admissions were screened and 8417 visits met criteria for inclusion. Seventy-five percent of procedures occurred before age 1. Complications occurred in 8.6% of patients: 6.6% of patients at age 0 to 6 months, 10.3% of patients aged 7 to 12 months, and 13.9% of patients 12 to 36 months. Patients with acrocephalosyndactyly or associated congenital anomalies experienced complications in 22.9% of cases (OR = 3.07, 95% CI = 2.33, 4.03). CONCLUSION Craniosynostosis repair is safe; however, the risk of complications increases with age at intervention. Presence of a syndromic congenital deformity at any age carries the greatest increased risk of perioperative complications. This suggests that optimal timing of intervention is within the first year of life, especially in those cases with additional factors increasing perioperative risk. These data support the importance of counseling patients of the increased risk associated with delaying craniosynostosis repair.
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Affiliation(s)
- William J Bruce
- 1 Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Victor Chang
- 1 Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Cara J Joyce
- 2 Department of Public Health Science, Loyola University Chicago, Maywood, IL, USA
| | - Adrienne N Cobb
- 3 Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Uma I Maduekwe
- 3 Department of Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Parit A Patel
- 4 Department of Surgery, Division of Plastic and Reconstructive Surgery, Loyola University Medical Center, Maywood, IL, USA.,5 Department of Pediatrics, Loyola University Medical Center, Maywood, IL, USA
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A New Operative One-Wing Technique to Correct Fronto-Orbital Region in Unilateral Nonsyndromic Plagiocephaly. J Craniofac Surg 2017; 29:167-169. [PMID: 29065042 DOI: 10.1097/scs.0000000000004047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Anterior plagiocephaly is a premature closing of unilateral coronal suture. This premature suture fusion causes a series of cranial asymmetry and alteration of the fronto-orbital region.The authors described a new surgical technique to correct the facial asymmetry that reduces the operative time and the possible complications.In a period between 2013and 2016, 12 children affected by nonsyndromic anterior plagiocephaly were treated with this new procedure.Clinical, cranial development, and absence of postoperative complication demonstrated that one-wing surgical bone correction is a useful and innovative technique.
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Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations. Neurosurgery 2017; 83:333-344. [DOI: 10.1093/neuros/nyx408] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/21/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Aditya V Karhade
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra M G Larsen
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Cote
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heloise M Dubois
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Lin Y, Mayer RR, Verla T, Raskin JS, Lam S. Is there a "July effect" in pediatric neurosurgery? Childs Nerv Syst 2017; 33:1367-1371. [PMID: 28501899 DOI: 10.1007/s00381-017-3432-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The belief that July, when resident physicians' training year begins, may be associated with increased risk of patient morbidity and mortality is known as the "July effect." This study aimed to compare complication rates after pediatric neurosurgical procedures in the first versus last academic quarters in two national datasets. METHODS Data were extracted from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database for year 2012 for 30-day complication events and the Kids' Inpatient Database (KID) for year 2012 for in-hospital complication events after pediatric neurosurgical procedures. Descriptive and analytic statistical methods were used to characterize the impact of seasonal variation between the first and last quarters on complications. RESULTS Three thousand six hundred twenty-four procedures in the NSQIP-P dataset and 14,855 hospitalizations in KID were included in the study cohort. No significant difference was observed between the first and fourth quarters for these complication events: wound disruption/dehiscence, wound infection, nerve injury, bleeding requiring transfusion, central line-associated BSI, deep venous thrombosis/pulmonary embolism, urinary tract infection, renal failure, re-intubation/pulmonary failure, cardiac arrest, stroke, coma, and death. There was no difference in the average length of stay or average length of surgical time. In the NSQIP-P, the first quarter was associated with a significantly increased incidence of pneumonia and unplanned re-operation; there was a trend towards increased incidence of unplanned re-admission and sepsis. In KID, there was no difference in the rate of pneumonia or sepsis. CONCLUSION For the majority of morbidity and mortality events, no significant difference was found in occurrence rates between the first and last quarters.
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Affiliation(s)
- Yimo Lin
- Department of Neurosurgery, Oregon Health and Sciences University, Portland, OR, USA
| | - Rory R Mayer
- Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Terence Verla
- Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA. .,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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Cruz AI, Kleiner JE, DeFroda SF, Gil JA, Daniels AH, Eberson CP. Increasing rates of surgical treatment for paediatric diaphyseal forearm fractures: a National Database Study from 2000 to 2012. J Child Orthop 2017; 11:201-209. [PMID: 28828064 PMCID: PMC5548036 DOI: 10.1302/1863-2548.11.170017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
FOREARM Purpose fractures are one of the most commonly sustained injuries in children and are often treated non-operatively. The purpose of this study was to estimate the rate of inpatient surgical treatment of paediatric forearm fractures over time using a large, publicly available, national database. METHODS The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was evaluated between 2000 and 2012. Forearm fractures and surgeries were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis and procedure codes. Univariable and multivariable logistic regression were used to determine variables associated with greater proportion of surgical treatment. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute Inc., Cary, NC, USA). Statistical significance was set at p < 0.05. RESULTS The database identified 30 936 forearm fracture admissions. Overall, 19 837 of these patients were treated surgically (64.12%). The percentage of patients treated with surgery increased from 59.3% in 2000 to 70.0% in 2012 (p < 0.001). Multivariable regression analysis found increased age (p < 0.001), more recent year (p < 0.001), male gender (p = 0.003) and admission to a children's hospital (p < 0.001) were associated with an increased proportion of patients receiving surgical treatment. Medicaid payer status was associated with a lower proportion of surgical treatment (p < 0.001). CONCLUSIONS The rate of operative treatment for paediatric forearm fractures admitted to the hospital increased over time. Increased surgical rates were associated with older age, male gender, treatment at a children's hospital and non-Medicaid insurance status.
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Affiliation(s)
- A. I. Cruz
- Department of Orthopaedics, Division of Paediatric Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA,Correspondence should be sent to: Dr A. I. Cruz Jr, Department of Orthopaedics, Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903, USA. E-mail:
| | - J. E. Kleiner
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - S. F. DeFroda
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - J. A. Gil
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - A. H. Daniels
- Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - C. P. Eberson
- Department of Orthopaedics, Division of Paediatric Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
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Shastin D, Peacock S, Guruswamy V, Kapetanstrataki M, Bonthron DT, Bellew M, Long V, Carter L, Smith I, Goodden J, Russell J, Liddington M, Chumas P. A proposal for a new classification of complications in craniosynostosis surgery. J Neurosurg Pediatr 2017; 19:675-683. [PMID: 28362186 DOI: 10.3171/2017.1.peds16343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complications have been used extensively to facilitate evaluation of craniosynostosis practice. However, description of complications tends to be nonstandardized, making comparison difficult. The authors propose a new pragmatic classification of complications that relies on prospective data collection, is geared to capture significant morbidity as well as any "near misses" in a systematic fashion, and can be used as a quality improvement tool. METHODS Data on complications for all patients undergoing surgery for nonsyndromic craniosynostosis between 2010 and 2015 were collected from a prospective craniofacial audit database maintained at the authors' institution. Information on comorbidities, details of surgery, and follow-up was extracted from medical records, anesthetic and operation charts, and electronic databases. Complications were defined as any unexpected event that resulted or could have resulted in a temporary or permanent damage to the child. RESULTS A total of 108 operations for the treatment of nonsyndromic craniosynostosis were performed in 103 patients during the 5-year study period. Complications were divided into 6 types: 0) perioperative occurrences; 1) inpatient complications; 2) outpatient complications not requiring readmission; 3) complications requiring readmission; 4) unexpected long-term deficit; and 5) mortality. These types were further subdivided according to the length of stay and time after discharge. The overall complication rate was found to be 35.9%. CONCLUSIONS The proportion of children with some sort of complication using the proposed definition was much higher than commonly reported, predominantly due to the inclusion of problems often dismissed as minor. The authors believe that these complications should be included in determining complication rates, as they will cause distress to families and may point to potential areas for improving a surgical service.
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Big data in facial plastic and reconstructive surgery: from large databases to registries. Curr Opin Otolaryngol Head Neck Surg 2017; 25:273-279. [PMID: 28525400 DOI: 10.1097/moo.0000000000000377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There are many limitations to performing clinical research with high levels of evidence in facial plastic and reconstructive surgery (FPRS), such as randomization into surgical groups and sample size recruitment. Therefore, additional avenues for exploring research should be explored using big data, from databases to registries. Other organizations have developed these tools in the evolving landscape of outcomes measurement and value in healthcare, which may serve as models for our specialty. RECENT FINDINGS Over the last 5 years, FPRS literature of large-scale outcomes research, utilizing several administrative databases, has steadily grown. Our objectives are to describe key administrative databases, strengths and weaknesses of each, and identify recent FPRS publications utilizing big data. A registry with FPRS defined outcomes has the most potential. SUMMARY Although FPRS research has trended to a more evidence-based approach in the modern healthcare era, gaps persist. Several large administrative databases or registries can address voids in outcomes research within FPRS.
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Kim DH, Morales M, Tai R, Hergenroeder G, Shah C, O'Leary J, Harrison N, Edquilang G, Paisley E, Allen-McBride E, Murphy A, Smith J, Gormley W, Spielman A. Quality Programs in Neurosurgery: The Memorial Hermann/University of Texas Experience. Neurosurgery 2017; 80:S65-S74. [PMID: 28375495 DOI: 10.1093/neuros/nyw158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Indexed: 11/14/2022] Open
Abstract
The importance of outcome measures is steadily increasing due to the rise of "pay for performance" and the advent of population health. In 2007, a quality initiative was started due to poor performance on rankings such as the University Health Consortium (UHC) report card. Inherent to all such efforts are common challenges: how to engage the providers; how to gather and ensure the accuracy of the data; how to attribute results to individuals; how to ensure permanent improvements. After analysis, a strategy was developed that included an initial focus on 3 metrics (mortality, infection rates, and complications), leadership from practicing neurosurgeons, protocol development and adherence, and subspecialization. In addition, it was decided that the metrics would initially apply to attending physicians only, but that the entire team would need to be involved. Once the fundamental elements were established, the process could be extended to other measures and providers. To support this effort, special information system tools were developed and a support team formed. As the program matured, measured outcomes improved and more metrics were added (to a current total of 48). For example, UHC mortality ratios (observed over expected) decreased by 75%. Infection rates decreased 80%. The program now involves all trainee physicians, advanced practice providers, nurses, and other staff. This paper describes the design, implementation, and results of this effort, and provides a practical guide that may be useful to other groups undertaking similar initiatives.
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Affiliation(s)
- Dong H Kim
- Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas
| | | | - Rahil Tai
- Memorial Hermann Healthcare System, Houston, Texas
| | - Georgene Hergenroeder
- Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas
| | - Chirag Shah
- Memorial Hermann Healthcare System, Houston, Texas
| | - Joanna O'Leary
- Department of Neurosurgery, The Uni-versity of Texas Medical School at Hous-ton, Houston, Texas
| | | | | | | | | | | | - Justin Smith
- Clear Path Solutions, Jamaica Plain, Massachusetts
| | - William Gormley
- Department of Neuro-surgery, Harvard Medical School, Cam-bridge, Massachusetts
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Kim DH. “The Coming Changes in Neurosurgical Practice”: A Supplement to Neurosurgery. Neurosurgery 2017; 80:S1-S3. [DOI: 10.1093/neuros/nyw145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/13/2016] [Indexed: 11/14/2022] Open
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Markiewicz MR, Alden T, Momin MV, Olsson AB, Jurado RJ, Abdullah F, Miloro M. Does Receiving a Blood Transfusion Predict for Length of Stay in Children Undergoing Cranial Vault Remodeling for Craniosynostosis? Outcomes Using the Pediatric National Surgical Quality Improvement Program Dataset. J Oral Maxillofac Surg 2017; 75:1732-1741. [PMID: 28238822 DOI: 10.1016/j.joms.2017.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Recent interventions have aimed at reducing the need for blood transfusions in the perioperative period in patients with craniosynostosis undergoing cranial vault remodeling. However, little is known regarding whether the receipt of a blood transfusion influences the length of hospital stay. The purpose of this study was to assess whether the receipt of a blood transfusion in patients undergoing cranial vault remodeling is associated with an increased length of stay. MATERIALS AND METHODS To address the research purposes, we designed a retrospective cohort study using the 2014 Pediatric National Surgical Quality Improvement Program (NSQIP Peds) dataset. The primary predictor variable was whether patients received a blood transfusion during cranial vault remodeling. The primary outcome variable was length of hospital stay after the operation. The association between the receipt of blood transfusions and length of stay was assessed using the Student t test. The association between other covariates and the outcome variable was assessed using linear regression, analysis of variance, and the Tukey test for post hoc pair-wise comparisons. RESULTS The sample was composed of 756 patients who underwent cranial vault remodeling: 503 who received blood transfusions and 253 who did not. The primary predictor variable of blood transfusion was associated with an increased length of stay (4.1 days vs 3.0 days, P = .03). Other covariates associated with an increased length of stay included race, American Society of Anesthesiologists status, premature birth, presence of a congenital malformation, and number of sutures involved in craniosynostosis. CONCLUSIONS The receipt of a blood transfusion in the perioperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with an increased length of stay.
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Affiliation(s)
- Michael R Markiewicz
- Assistant Professor, Department of Oral & Maxillofacial Surgery, University of Illinois at Chicago, Attending Physician, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University Chicago, IL, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Tord Alden
- Attending Physician, Neurosurgery; Chief Medical Informatics Officer; Assistant Professor, Pediatric Neurosurgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mohmed Vasim Momin
- Resident, Department of Oral & Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL
| | - Alexis B Olsson
- Chief and Clinical Professor, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery; Feinberg School of Medicine, Northwestern University, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ray J Jurado
- Head, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Fizan Abdullah
- Vice-Chair, Department of Surgery; Head, Division of Pediatric Surgery; Program Director, Fellowship in Pediatric Surgery; Professor of Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Miloro
- Professor and Head, Department of Oral & Maxillofacial Surgery, University of Illinois at Chicago, Clinical Professor, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University Chicago, IL
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Boulos A, DeFroda SF, Kleiner JE, Thomas N, Gil JA, Cruz AI. Inpatient orthopaedic hardware removal in children: A cross-Sectional study. J Clin Orthop Trauma 2017; 8:270-275. [PMID: 28951646 PMCID: PMC5605744 DOI: 10.1016/j.jcot.2017.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/11/2017] [Accepted: 06/29/2017] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Few data describe the specific reasons for inpatient hardware removal in the pediatric population. This study was designed to understand the conditions necessitating inpatient removal following fracture surgery. Cost data was analyzed to understand the financial implications of these procedures. METHODS The Kids' Inpatient Database (KID) was evaluated for the year 2012. Patients undergoing open reduction internal fixation following upper and lower extremity fractures as well as those undergoing hardware removal due to hardware complications were identified using ICD-9 CM diagnosis and procedure codes. Univariable and multivariable logistic regression were used to determine predictors of surgical removal due to complications, controlling for patient demographics and comorbidities. RESULTS The most common indication for removal was infection (1141 patients; 32%), followed by mechanical dysfunction (923; 25.4%), and pain (472; 13%). Logistic regression analysis showed that femur fractures (OR = 8.27, 95% CI: 7.63-8.96) and tibia/fibula fractures (OR = 1.24, 95% CI: 1.17-1.35) were independent predictors of infection-related hardware removal (P < 0.001). Patients who underwent removal due to infection were more likely to have asthma (OR = 1.87, 95% CI: 1.62-2.07), smoke tobacco (OR = 1.12, 95% CI: 1.05-1.23), and suffer from developmental delays (OR = 1.32, 95% CI: 1.19-1.54) (P < 0.001). Average hospital charges and costs were $36,349 and $11,792 respectively. CONCLUSION While most commonly performed as an outpatient procedure, inpatient hardware removal occurs with relative frequency and is most often performed for infection, mechanical failure, or pain. Risk factors for infection-related removal were identified and provide a basis for further investigation.
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Affiliation(s)
- Alexandre Boulos
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, United States,Corresponding author at: Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, United States.
| | - Steven F. DeFroda
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, United States
| | - Justin E. Kleiner
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, United States
| | - Nathan Thomas
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, United States
| | - Joseph A. Gil
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, United States
| | - Aristides I. Cruz
- Department of Orthopaedics Division of Pediatric Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI, United States
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