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Adapa AR, Linzey JR, Moriguchi F, Daou BJ, Khalsa SSS, Ponnaluri-Wears S, Thompson BG, Park P, Pandey AS. Risk factors and morbidity associated with surgical site infection subtypes following adult neurosurgical procedures. Br J Neurosurg 2024; 38:503-509. [PMID: 33779461 DOI: 10.1080/02688697.2021.1905773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies on surgical site infection (SSI) in adult neurosurgery have presented all subtypes of SSIs as the general 'SSI'. Given that SSIs constitute a broad range of infections, we hypothesized that clinical outcomes and management vary based on SSI subtype. METHODS A retrospective analysis of all neurosurgical SSI from 2012-2019 was conducted at a tertiary care institution. SSI subtypes were categorized as deep and superficial incisional SSI, brain, dural or spinal abscesses, meningitis or ventriculitis, and osteomyelitis. RESULTS 9620 craniotomy, shunt, and fusion procedures were studied. 147 procedures (1.5%) resulted in postoperative SSI. 87 (59.2%) of these were associated with craniotomy, 36 (24.5%) with spinal fusion, and 24 (16.3%) with ventricular shunting. Compared with superficial incisional primary SSI, rates of reoperation to treat SSI were highest for deep incisional primary SSI (91.2% vs 38.9% for superficial, p < 0.001) and second-highest for intracranial SSI (90.9% vs 38.9%, p = 0.0001). Postoperative meningitis was associated with the highest mortality rate (14.9%). Compared with superficial incisional SSI, the rate of readmission for intracranial SSI was highest (57.6% vs 16.7%, p = 0.022). CONCLUSION Deep incisional and organ space SSI demonstrate a greater association with morbidity relative to superficial incisional SSI. Future studies should assess subtypes of SSI given these differences.
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Affiliation(s)
- Arjun R Adapa
- Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Joseph R Linzey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Badih J Daou
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | | | - Paul Park
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
- Department of Orthopedic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA
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2
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Boethun A, Vissing NH, Mathiasen R, Skjøth-Rasmussen J, Foss-Skiftesvik J. CNS infection in children with brain tumors: adding ventriculostomy to brain tumor resection increases risk more than 20-fold. Childs Nerv Syst 2023; 39:387-394. [PMID: 36536059 DOI: 10.1007/s00381-022-05799-8] [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: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the risk of central nervous system (CNS) infections in children undergoing neurosurgery for brain tumors. METHODS Single-center retrospective cohort study including all children with brain tumors undergoing neurosurgical treatment over an 11-year period. RESULTS A total of 274 patients undergoing 733 neurosurgical procedures were included. Overall, 12.8% of patients were diagnosed with a CNS infection during their course of treatment. CNS infections were more frequent among children treated with CSF diversion (p < 0.001) and independently associated with low age (OR/y 0.9 (CI 95% 0.769-0.941), intraventricular (OR 2.8, CI 95% 1.2-6.5), and high-grade tumors (OR 2.7, CI 95% 1.1-6.5). The majority of CNS infections occurred within 30 days of surgery, resulting in a postoperative CNS infection rate of 5.3%. Postoperative CNS infections were significantly more frequent following adjunct EVD placement during tumor resection compared to a stand-alone craniotomy (30.4% vs. 1.5%, RR 20.6, CI 95% 5.7-72.2). CONCLUSION CNS infections affect at least 12% of children with brain tumors and are associated with age, tumor location, and grade. Adding EVD to tumor surgery increases the risk of postoperative CNS infection, and reconsidering routine adjunct EVD placement is therefore advocated.
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Affiliation(s)
- Anna Boethun
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark. .,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
| | - Nadja Hawwa Vissing
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jon Foss-Skiftesvik
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark. .,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
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3
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Alexiades NG, Shao B, Ahn ES, Blount JP, Brockmeyer DL, Hankinson TC, Nesvick CL, Sandberg DI, Heuer GG, Saiman L, Feldstein NA, Anderson RCE. High prevalence of gram-negative and multiorganism surgical site infections after pediatric complex tethered spinal cord surgery: a multicenter study. J Neurosurg Pediatr 2022; 30:357-363. [PMID: 35901675 DOI: 10.3171/2022.6.peds2238] [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: 01/29/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complex tethered spinal cord (cTSC) release in children is often complicated by surgical site infection (SSI). Children undergoing this surgery share many similarities with patients undergoing correction for neuromuscular scoliosis, where high rates of gram-negative and polymicrobial infections have been reported. Similar organisms isolated from SSIs after cTSC release were recently demonstrated in a single-center pilot study. The purpose of this investigation was to determine if these findings are reproducible across a larger, multicenter study. METHODS A multicenter, retrospective chart review including 7 centers was conducted to identify all cases of SSI following cTSC release during a 10-year study period from 2007 to 2017. Demographic information along with specific microbial culture data and antibiotic sensitivities for each cultured organism were collected. RESULTS A total of 44 SSIs were identified from a total of 655 cases, with 78 individual organisms isolated. There was an overall SSI rate of 6.7%, with 43% polymicrobial and 66% containing at least one gram-negative organism. Half of SSIs included an organism that was resistant to cefazolin, whereas only 32% of SSIs were completely susceptible to cefazolin. CONCLUSIONS In this study, gram-negative and polymicrobial infections were responsible for the majority of SSIs following cTSC surgery, with approximately half resistant to cefazolin. Broader gram-negative antibiotic prophylaxis should be considered for this patient population.
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Affiliation(s)
| | - Belinda Shao
- 2Department of Neurosurgery, Brown University, Providence, Rhode Island
| | - Edward S Ahn
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey P Blount
- 4Division of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Douglas L Brockmeyer
- 5Department of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Todd C Hankinson
- 6Department of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, Colorado
| | - Cody L Nesvick
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - David I Sandberg
- 7Division of Pediatric Neurosurgery, McGovern Medical School/UT Health/Children's Memorial Hermann Hospital, Houston, Texas
| | - Gregory G Heuer
- 8Department of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Lisa Saiman
- 9Department of Pediatric Infectious Disease, Columbia University Medical Center, New York, New York
| | - Neil A Feldstein
- 10Department of Neurological Surgery, Columbia University Medical Center, New York, New York; and
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4
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Johnson RF, Teplitzky T, Wynings EM, Kou Y, Chorney SR. Surgical site infections after pediatric open airway reconstruction—A National Surgical Quality Improvement Program‐Pediatric analysis. Laryngoscope Investig Otolaryngol 2022; 7:1618-1625. [PMID: 36258868 PMCID: PMC9575049 DOI: 10.1002/lio2.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 08/06/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives To determine the rate of surgical site infections (SSI) after pediatric open airway reconstruction using a nationwide database. Study Design Cross‐sectional study of the American College of Surgeons National Surgical Quality Improvement Program‐Pediatric (ACS NSQIP‐P) Database. Methods The ACS NSQIP‐P was queried for open airway surgeries between 2013 and 2019 determining postoperative SSI and wound dehiscence with a random sample of non‐airway cases serving as a control group. Results A total of 637 laryngotracheoplasties (LTP), 411 tracheal resections (TR) and 2100 control procedures were included. LTP and TR were both performed on younger children with more comorbidities than control surgeries (p < .05). Postoperative wound complications occurred more often after airway reconstructions than non‐airway cases (6.4% vs. 2.9%, p < .001). Compared to non‐airway procedures, LTP (OR: 2.42, 95% CI: 1.62–3.61) and TR (OR: 2.07, 95% CI: 1.28–3.66) developed increased SSI. Multiple logistic regression identified dirty or infected wounds (OR: 4.61, p < .001, 95% CI: 2.35–9.03) and American Society of Anesthesiologists (ASA) Class IV (OR: 3.19, p = .02, 95% CI: 1.12–8.39) as the strongest predictors of SSI after airway reconstruction. Conclusions SSI after pediatric airway reconstruction occur in 6% of cases and are increased in infected wounds and ASA Class IV surgeries. Recognizing common factors for these complications provide reliable benchmarking to design surgical quality improvement initiatives. Level of Evidence 4.
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Affiliation(s)
- Romaine F. Johnson
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatric Otolaryngology Children's Medical Center Dallas Dallas Texas USA
| | - Taylor Teplitzky
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
| | - Erin M. Wynings
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
| | - Yann‐Fuu Kou
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatric Otolaryngology Children's Medical Center Dallas Dallas Texas USA
| | - Stephen R. Chorney
- Department of Otolaryngology–Head & Neck Surgery University of Texas Southwestern Medical Center Dallas Texas USA
- Department of Pediatric Otolaryngology Children's Medical Center Dallas Dallas Texas USA
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5
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Holste KG, Chopra Z, Saleh S, Saadeh YS, Park P, Maher CO. Editorial. The use of big data for improving understanding of the natural history of neurosurgical disease. Neurosurg Focus 2022; 52:E2. [DOI: 10.3171/2022.1.focus21712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Zoey Chopra
- Department of Neurosurgery and
- School of Medicine, University of Michigan, Ann Arbor, Michigan
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6
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Staphylococcus aureus infections after elective pediatric surgeries. Infect Control Hosp Epidemiol 2022; 43:1625-1633. [DOI: 10.1017/ice.2021.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective:
To determine the 180-day cumulative incidence of culture-confirmed Staphylococcus aureus infections after elective pediatric surgeries.
Design:
Retrospective cohort study utilizing the Premier Healthcare database (PHD).
Setting:
Inpatient and hospital-based outpatient elective surgical discharges.
Patients:
Pediatric patients <18 years who underwent surgery during elective admissions between July 1, 2010, and June 30, 2015, at any of 181 PHD hospitals reporting microbiology results.
Methods:
In total, 74 surgical categories were defined using ICD-9-CM and CPT procedure codes. Microbiology results and ICD-9-CM diagnosis codes defined S. aureus infection types: bloodstream infection (BSI), surgical site infection (SSI), and other types (urinary tract, respiratory, and all other). Cumulative postsurgical infection incidence was calculated as the number of infections divided by the number of discharges with qualifying elective surgeries.
Results:
Among 11,874 inpatient surgical discharges, 180-day S. aureus infection incidence was 1.79% overall (1.00% SSI, 0.35% BSI, 0.45% other). Incidence was highest among children <2 years of age (2.76%) and lowest for those 10–17 years (1.49%). Among 50,698 outpatient surgical discharges, incidence was 0.36% overall (0.23% SSI, 0.05% BSI, 0.08% others); it was highest among children <2 years of age (0.57%) and lowest for those aged 10–17 years (0.30%). MRSA incidence was significantly higher after inpatient surgeries (0.68%) than after outpatient surgeries (0.14%; P < .0001). Overall, the median days to S. aureus infection was longer after outpatient surgery than after inpatient surgery (39 vs. 31 days; P = .0116).
Conclusions:
These findings illustrate the burden of postoperative S. aureus infections in the pediatric population, particularly among young children. These results underscore the need for continued infection prevention efforts and longer-term surveillance after surgery.
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Cediel EG, Boerwinkle VL, Ramon JF, Arias D, De la Hoz-Valle JA, Mercado JD, Cohen D, Niño MC. Length of preoperative hospital stay is the dominating risk factor for surgical site infection in neurosurgery: A cohort data-driven analysis. Surg Neurol Int 2022; 13:80. [PMID: 35399909 PMCID: PMC8986656 DOI: 10.25259/sni_1237_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background: The number of days of preoperative hospital stay (PHS) is a modifiable variable that has shown contradictory surgical site infection (SSI) risk factor results in neurosurgery. We sought to pinpoint the day of PHS length related with a marked increase of risk of SSI. Methods: From a tertiary teaching hospital, January 2015–December 2017, prospectively collected nonpercutaneous neurosurgery procedures with standard antibiotic prophylaxis and 1-year follow-up were evaluated. SSI risk factors were assessed through multiple logistic regression models with different thresholds of PHS. Results: A total of 1012 procedures were included in the study. Incidence of SSI was 4.4%. The median PHS was higher in those with SSI than in those without (1 day, interquartile range [IQR]: 7 vs. 0 days, IQR: 1, respectively, P = 0.002). By the amount of six days of PHS, this exposure risk past the threshold of significance for impact on wound infection (OR 2.8; CI 1.23–6.39, P = 0.014). Operative time past 4 h (OR 2.11; CI 1.12-3.98; P = 0.021), and in some models, previous surgery at same admission were also identified by multivariate analysis as increasing postoperative SSI risk. Conclusion: The gradual increase of the SSI OR associated with longer PHS days was the highest risk factor of SSI in our cohort of patients. Studies directed to reduce this complication should consider the PHS.
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Affiliation(s)
- Emilio Garzón Cediel
- Department of Neurosurgery, Clínica de Marly Jorge Cavelier Gaviria, Chía, Cundinamarca, Colombia, United States,
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Varina Louise Boerwinkle
- Department of Pediatric Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, Arizona, United States,
| | - Juan Fernando Ramon
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Diana Arias
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Jose Antonio De la Hoz-Valle
- Department of Clinical Research, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Jose Dario Mercado
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Darwin Cohen
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Maria Claudia Niño
- Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Cundinamarca, Colombia
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8
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Alanazi AM, Alabdullatif SK, Alghamdi AS, Zamzami AA, Almazyad L, Alakel AM, Alzahrani MAA, Almazyad LT, AlRuwaili RH, Almuhaysin MIA. Epilepsy in Patients with Craniosynostosis: A Systematic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/negpa51wkn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Mohammadi E, Azadnajafabad S, Goudarzi M, Tayebi Meybodi K, Nejat F, Habibi Z. Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial. J Neurosurg Pediatr 2021:1-8. [PMID: 34861647 DOI: 10.3171/2021.9.peds21416] [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: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. METHODS All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score-matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88-1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. RESULTS The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27-1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12-3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14-2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13-3.31). CONCLUSIONS No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.
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Affiliation(s)
- Esmaeil Mohammadi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran
| | - Sina Azadnajafabad
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran.,2Department of Surgery, Tehran University of Medical Sciences, Tehran; and
| | - Mehrdad Goudarzi
- 3Department of Pediatric Anesthesiology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Tayebi Meybodi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran
| | - Farideh Nejat
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran
| | - Zohreh Habibi
- 1Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran
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10
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Wach J, Yildiz ÖC, Sarikaya-Seiwert S, Vatter H, Haberl H. Predictors of postoperative complications after selective dorsal rhizotomy. Acta Neurochir (Wien) 2021; 163:463-474. [PMID: 32691268 DOI: 10.1007/s00701-020-04487-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy (CP). We analyzed potential preoperative predictors of complications after SDR via single-level laminectomy at the conus medullaris. METHODS One hundred and forty SDRs performed in children (2-17 years) with CP were included in this retrospective study (March 2016 to July 2019). Of these children, 69% were ambulatory (Gross Motor Functional Classification System (GMFCS) II and III). Variables associated with wound dehiscence and infections, cerebrospinal fluid (CSF) leaks, and prolonged epidural pain management were analyzed statistically. RESULTS Five children (3.6%) showed prolonged wound healing, which was associated with obesity (BMI z-score ≥ 1.64; odds ratio (OR) 24.4; 95% confidence interval (CI) 3-199; p = 0.003). Two cases (1.4%) had superficial surgical site infections (SSIs), which was associated with obesity (p = 0.004) and thrombocytopenia (< 180,000 G/l; p = 0.028). The area under the curve at ≥ 1.55 BMI z-score for SSI was 0.97 (95% CI 0.93-0.99, p = 0.024), with a sensitivity and specificity for SSI of 100 and 94.9%, respectively. CSF leaks occurred in four (2.9%) children, associated with age ≤ 5 years (p = 0.029). Fifteen (10.7%) children required prolonged (4-5 days) epidural pain treatment, which was associated with non-ambulatory GMFCS levels (IV and V) (OR 3.6; 95% CI 1.2-10.8; p = 0.008). CONCLUSIONS SDR is safe for all GMFCS levels. Obesity predicts prolonged wound healing and SSI. Prolonged pain management via epidural pain catheter is safe, but care should be taken with non-ambulatory children.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University of Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany.
| | - Ömer Can Yildiz
- Department of Neurosurgery, University of Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany
| | - Sevgi Sarikaya-Seiwert
- Department of Neurosurgery, University of Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University of Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany
| | - Hannes Haberl
- Department of Neurosurgery, University of Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany
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11
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Wach J, Banat M, Borger V, Vatter H, Haberl H, Sarikaya-Seiwert S. Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes. J Neurol Surg A Cent Eur Neurosurg 2020; 82:64-74. [PMID: 32968998 DOI: 10.1055/s-0040-1714413] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. METHODS MEDLINE/PubMed Service was searched for the terms "intraoperative MRI," "pediatric," "brain," "tumor," "glioma," and "surgery." The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. RESULTS IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6-89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1-85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7-2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. CONCLUSION IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Mohammad Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hannes Haberl
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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12
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Shi YJ, Zheng GH, Qian LY, Qsman RA, Li GG, Zhang GJ. Longitudinal Analysis of Risk Factors for Clinical Outcomes of Enterobacteriaceae Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014-2019. Infect Drug Resist 2020; 13:2161-2170. [PMID: 32753912 PMCID: PMC7351632 DOI: 10.2147/idr.s252331] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Our study is a retrospective observational study conducted in one of the largest clinical centers of neurosurgery in China. We aimed to investigate the antimicrobial susceptibility patterns of the Enterobacteriaceae isolates responsible for nosocomial meningitis/encephalitis in post-neurosurgical patients. Meanwhile, we tried to evaluate the risk factors for mortality following Enterobacteriaceae meningitis/encephalitis. Patients and Methods Medical data on clinical characteristics, antibiotic susceptibilities, and mortality were reviewed until patients’ discharge or death in the hospital. Data for a total of 164 cerebrospinal fluid (CSF) infection cases due to Enterobacteriaceae after neurosurgery were collected between January 2014 and November 2019 in order to identify risk factors affecting the outcome. Kaplan–Meier survival analysis and multivariable Cox proportional hazard models were applied. Results In this study, a total of 2416 neurosurgical meningitis/encephalitis cases were reported between 2014 and 2019. Enterobacteriaceae accounted for 7.3% (176/2416) of all the bacterial infections. Of them, 164 Enterobacteriaceae isolates were available to divide into two groups according to the final outcome of whether the patient died or survived. In total, 38 patients died (23.2%) and 126 patients survived (76.8%). The most frequent infecting species was Klebsiella pneumoniae (47.0%, 77/164). Fourteen-day and 30-day mortality rates were 7.9% (13/164) and 15.2% (25/164). Kaplan–Meier survival analysis revealed that the risk factors of Enterobacteriaceae meningitis/encephalitis that resulted in poor outcomes included comorbidities, Glasgow Coma Scale (GCS) score, sepsis, intensive care unit (ICU) admission, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, and ventilation. A GCS score of less than or equal to 8 (P=0.04, HR 2.562) was identified to be a significant risk factor for mortality according to the multivariable Cox proportional hazards model. Conclusion In-hospital mortality caused by Enterobacteriaceae meningitis/encephalitis in neurosurgery was high. A GCS score of ≤8 was an independent risk factor for mortality following Enterobacteriaceae meningitis/encephalitis in post-neurosurgical patients.
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Affiliation(s)
- Yi-Jun Shi
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Guang-Hui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Ling-Ye Qian
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Rasha Alsamani Qsman
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Guo-Ge Li
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
| | - Guo-Jun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, People's Republic of China
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13
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Ichinose T, Miyashita K, Tanaka S, Oikawa N, Oishi M, Nambu I, Kinoshita M, Nakada M. Recurrent Spinal Intramedullary Arachnoid Cyst: Case Report and Literature Review. World Neurosurg 2020; 138:68-72. [PMID: 32142944 DOI: 10.1016/j.wneu.2020.02.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Symptomatic intramedullary arachnoid cysts are rarely observed lesions, particularly in the pediatric age group. Treatment includes cyst fenestration or resection of the cyst wall, and recurrence after surgery has never been reported. We report a rare case of a spinal intramedullary arachnoid cyst, which recurred after cyst fenestration and required reoperation after a certain period. CASE DESCRIPTION A 4-year-old boy presented to our hospital with tetraparesis and bladder and rectum disorder. A cystic intramedullary lesion in the cervical spinal cord was detected in preoperative imaging. An emergency fenestration of cyst was performed, and his symptoms were resolved immediately. One month after the operation, the symptoms and cyst recurred. The symptoms improved in the natural course without reoperation. However, the cyst increased in size and the symptoms recurred after 27 months from the first relapse and the cyst was removed urgently. The diagnosis was an arachnoid cyst. After the reoperation, the cyst has disappeared and not recurred. CONCLUSIONS To the best of our knowledge, this is the first report of recurrence of an intramedullary arachnoid cyst. This case indicates the importance of considering the resection of cyst wall as possible because of the probability of cyst recurrence after fenestration, while careful observation is the option in the short term, especially for children or high-risk cases.
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Affiliation(s)
- Toshiya Ichinose
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | | | - Shingo Tanaka
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Nozomu Oikawa
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Iku Nambu
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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14
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Guanghui Z, Jing L, Guojun Z, Hong L. Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae. J Infect Chemother 2020; 26:101-106. [DOI: 10.1016/j.jiac.2019.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/07/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022]
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15
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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] [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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16
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Sherrod BA, McClugage SG, Mortellaro VE, Aban IB, Rocque BG. Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients. J Pediatr Surg 2019; 54:631-639. [PMID: 30361075 PMCID: PMC6451662 DOI: 10.1016/j.jpedsurg.2018.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery. METHODS 153,220 inpatient pediatric surgical patients were selected from the 2012-2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan-Meier survival analysis. RESULTS 305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81%) occurred predischarge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p = 0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p < 0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA < 3. Preoperative, postoperative, and total LOSs were longer for patients with VTE (p < 0.001 for each). ASA ≥ 3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic = 0.83). CONCLUSIONS Pediatric postsurgical patients have unique risk factors for developing VTE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Brandon A Sherrod
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL.
| | - Samuel G McClugage
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
| | - Vincent E Mortellaro
- Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
| | - Inmaculada B Aban
- Department of Biostatistics, The University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Brandon G Rocque
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
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17
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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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Abdi H, Elzayat E, Cagiannos I, Lavallée LT, Cnossen S, Flaman AS, Mallick R, Morash C, Breau RH. Female radical cystectomy patients have a higher risk of surgical site infections. Urol Oncol 2018; 36:400.e1-400.e5. [PMID: 30064934 DOI: 10.1016/j.urolonc.2018.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) are common after radical cystectomy. The objectives of this study were to evaluate if female sex is associated with postoperative SSI and if experiencing an SSI was associated with subsequent adverse events. METHODS This was a historical cohort study of radical cystectomy patients from the American College of Surgeons' National Surgical Quality Improvement Program database between 2006 and 2016. The primary outcome was development of a SSI (superficial, deep, or organ/abdominal space) within 30 days of surgery. Multivariable logistic regression analyses were performed to determine the association between sex and other patient/procedural factors with SSI. Female patients with SSI were also compared to those without SSI to determine risk of subsequent adverse events. RESULTS A total of 9,275 radical cystectomy patients met the inclusion criteria. SSI occurred in 1,277(13.7%) patients, 308 (16.4%) females and 969 (13.1%) males (odds ratio = 1.27; 95% confidence interval 1.10-1.47; P = 0.009). Infections were superficial in 150 (8.0%) females versus 410 (5.5%) males (P < 0.0001), deep in 40 (2.1%) females versus 114 (1.5%) males (P = 0.07), and organ/abdominal space in 118 (6.2%) females versus 445 (6.0%) males (P = 0.66). On multivariable analysis, female sex was independently associated with SSI (odds ratio = 1.21 confidence interval 1.01-1.43 P = 0.03). Females who experience SSI had higher probability of developing other complications including wound dehiscence, septic shock, and need for reoperation (all P < 0.05). CONCLUSIONS Female sex is an independent risk factor for SSI following radical cystectomy. More detailed study of patient factors, pathogenic microbes, and treatment factors are needed to prescribe the best measures for infection prophylaxis.
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Affiliation(s)
- Hamidreza Abdi
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ehab Elzayat
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Sonya Cnossen
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Anathea S Flaman
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Chris Morash
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Box 222, Ottawa, ON, Canada.
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Meng Y, Voisin MR, Suppiah S, Merali Z, Moghaddamjou A, Alotaibi NM, Manicat-Emo A, Weiss S, Go C, McCoy B, Donner EJ, Rutka JT. Risk factors for surgical site infection after intracranial electroencephalography monitoring for epilepsy in the pediatric population. J Neurosurg Pediatr 2018; 22:31-36. [PMID: 29624147 DOI: 10.3171/2018.1.peds17476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial electroencephalography (iEEG) monitoring is an important method of identifying the seizure focus in patients with medically refractory epilepsy. While previous studies have demonstrated low rates of surgical complications, reported rates of surgical site infection (SSI) are highly variable. To date, no studies have specifically evaluated the patient or operative risk factors contributing to SSI. The goals of this study were to examine the rate of SSI after iEEG monitoring for epilepsy workup in pediatric patients and to determine the variables that might contribute to the development of SSI. METHODS A retrospective analysis of hospital charts at the Hospital for Sick Children was performed for all patients who had undergone iEEG monitoring between 2000 and 2016. Univariate and multivariate analyses were performed to look for statistically significant variables in relation to SSI. RESULTS Among 199 patients eligible for analysis, 8 (4.0%) developed SSIs within a period ranging from 21 to 51 days postoperatively. Univariate analysis yielded 4 factors related to SSI: number of people present in the operating room on electrode insertion (p = 0.02), length of insertion surgery (p = 0.04), previous operation at the same surgical site (p = 0.04), and number of depth electrodes inserted (p = 0.01). Multivariate analysis revealed that both the number of people present during the implant operation (OR 0.08, 95% CI 0.01-0.70) and the number of depth electrodes inserted (OR 3.52, 95% CI 1.44-8.59) independently contributed to SSI. CONCLUSIONS This is the largest case series and the first comprehensive review of both patient and operative risk factors in the development of SSI from iEEG monitoring in a pediatric population. The authors' institution had a lower rate of infection than those in most other studies, which could be explained by their protocol of administering intravenous antibiotics perioperatively and post-implant removal antibiotics for 14 days. The authors found a correlation between SSI and the number of people present during the implant operation, as well as the number of depth electrodes; both may contribute to breaks in sterility.
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Affiliation(s)
- Ying Meng
- 1Division of Neurosurgery, University of Toronto; and
| | | | | | - Zamir Merali
- 1Division of Neurosurgery, University of Toronto; and
| | | | | | | | | | | | | | | | - James T Rutka
- 1Division of Neurosurgery, University of Toronto; and.,3Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Colaco M, Hester A, Visser W, Rasper A, Terlecki R. Relative to open surgery, minimally-invasive renal and ureteral pediatric surgery offers no improvement in 30-day complications, yet requires longer operative time: Data from the National Surgical Quality Improvement Program Pediatrics. Investig Clin Urol 2018; 59:200-205. [PMID: 29744478 PMCID: PMC5934283 DOI: 10.4111/icu.2018.59.3.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Performance of minimally-invasive surgery (MIS) is increasing relative to open surgery. We sought to compare the contemporary rates of short-term complications of open versus laparoscopic renal and ureteral surgery in pediatric patients. Materials and Methods A retrospective cross-sectional analysis of the National Surgical Quality Improvement Program Pediatrics database was performed of all cases in 2014 identified using CPT procedure codes for nephrectomy, partial nephrectomy (PN), ureteroneocystostomy (UNC), and pyeloplasty, and reviewed for postoperative complications. Univariate analysis was performed to determine 30-day complications, with comparison between open and MIS approaches. Receiver operator curve (ROC) analysis was performed to determine differences in body surface area (BSA) and age for open versus MIS. Results Review identified 207 nephrectomies, 72 PN, 920 UNC, and 625 pyeloplasties. MIS was associated with older age and larger BSA except for cases of UNC. Apart from PN, operative durations were longer with MIS. However, only PN was associated with significantly longer length of hospital stay (LOS). There was no difference in incidence of all other 30-day complications. When evaluating BSA via ROC, the area under the curve (AUC) was found to be 0.730 and was significant. Children with a BSA greater than 0.408 m2 were more likely to have MIS (sensitivity, 66.9%; specificity, 69.3%). Regarding age, the AUC was 0.732. Children older than 637.5 days were more likely to have MIS (sensitivity, 72.8%; specificity, 63.3%). Conclusions Pediatric MIS is associated with longer operative time for nephrectomy, but shorter LOS following PN. Surgical approach was not associated with difference in short-term complications.
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Affiliation(s)
- Marc Colaco
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Austin Hester
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William Visser
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alison Rasper
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ryan Terlecki
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Jiménez-Guerra R, Coronado-Zarco I, Zamora-Escudero R, García-May P, Yescas-Buendía G, González-Gómez L, Arroyo-Cabrales L, Echániz-Avilés M, Valencia-Contreras C, Ayala-Hernández M. Recién nacidos vivos con defectos del tubo neural en el Instituto Nacional de Perinatología de la Ciudad de México. Características demográficas y epidemiológicas. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2018. [DOI: 10.1016/j.rprh.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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22
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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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Chotai S, Guidry BS, Chan EW, Sborov KD, Gannon S, Shannon C, Bonfield CM, Wellons JC, Naftel RP. Unplanned readmission within 90 days after pediatric neurosurgery. J Neurosurg Pediatr 2017; 20:542-548. [PMID: 29027867 DOI: 10.3171/2017.6.peds17117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Readmission and return to operating room after surgery are increasingly being used as a proxy for quality of care. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in health care costs. The authors set out to analyze the incidence of readmission at their center, to define causes of unplanned readmission, and to determine the preoperative and surgical variables associated with readmissions following pediatric neurosurgery. METHODS A total of 536 children who underwent operations for neurosurgical diagnoses between 2012 and 2015 and who were later readmitted were included in the final analysis. Unplanned readmissions were defined to have occurred as a result of complications within 90 days after index surgery. Patient records were retrospectively reviewed to determine the primary diagnosis, surgery indication, and cause of readmission and return to operating room. The cost for index hospitalization, readmission episode, and total cost were derived based on the charges obtained from administrative data. Bivariate and multivariable analyses were conducted. RESULTS Of 536 patients readmitted in total, 17.9% (n = 96) were readmitted within 90 days. Of the overall readmissions, 11.9% (n = 64) were readmitted within 30 days, and 5.97% (n = 32) were readmitted between 31 and 90 days. The median duration between discharge and readmission was 20 days (first quartile [Q1]: 9 days, third quartile [Q3]: 36 days). The most common reason for readmission was shunt related (8.2%, n = 44), followed by wound infection (4.7%, n = 25). In the risk-adjusted multivariable logistic regression model for total 90-day readmission, patients with the following characteristics: younger age (p = 0.001, OR 0.886, 95% CI 0.824-0.952); "other" (nonwhite, nonblack) race (p = 0.024, OR 5.49, 95% CI 1.246-24.2); and those born preterm (p = 0.032, OR 2.1, 95% CI 1.1-4.12) had higher odds of being readmitted within 90 days after discharge. The total median cost for patients undergoing surgery in this study cohort was $11,520 (Q1: $7103, Q3: $19,264). For the patients who were readmitted, the median cost for a readmission episode was $8981 (Q1: $5051, Q3: $18,713). CONCLUSIONS Unplanned 90-day readmissions in pediatric neurosurgery are primarily due to CSF-related complications. Patients with the following characteristics: young age at presentation; "other" race; and children born preterm have a higher likelihood of being readmitted within 90 days after surgery. The median cost was > $8000, which suggests that the readmission episode can be as expensive as the index hospitalization. Clearly, readmission reduction has the potential for significant cost savings in pediatric neurosurgery. Future efforts, such as targeted education related to complication signs, should be considered in the attempt to reduce unplanned events. Given the single-center, retrospective study design, the results of this study are primarily applicable to this population and cannot necessarily be generalized to other institutions without further study.
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