Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics
Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics
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DOI：
10.3171/2016.10.peds16414
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发表时间：
2017-03-01
影响因子：
1.9
通讯作者：
Rice, Henry E.
中科院分区：
文献类型：
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作者：
Kuo, Benjamin J.;Vissoci, Joao Ricardo N.;Rice, Henry E.
目的：现有研究表明，儿童神经外科手术后不良事件（AE）的总体发生率较高。然而，鲜为人知的是，关于特定程序的发病率或与风险因素的关联，以帮助指导质量改进（QI）的举措。本研究的目的是通过使用美国外科医师学会（ACS）国家外科质量改进计划儿科（NSQIP-Peds）数据库平台描述小儿神经外科手术的30天死亡率和不良事件发生率。方法从2012-2014年NSQIP-Peds参与者用户文件中获取9996例小儿神经外科患者的数据。按照NSQIP-Peds目标手术类别分析神经外科病例，包括开颅术/颅骨切除术、缺损修复、椎板切除术、分流术和植入物。主要结局指标为30天死亡率，次要结局包括个体AE、复合发病率（所有AE，不包括死亡和计划外再次手术）、手术部位感染和计划外再次手术。使用Fischer精确检验对个体AE和患者特征进行单变量分析。使用Student t检验检查个体AE与连续变量（从入院到手术的持续时间、工作相对价值单位和手术时间）之间的相关性。通过单变量分析，与任何AE相关的患者特征和连续变量用于通过向后逐步logistic regression.Results开发类别特异性多变量模型。作者分析了3383例开颅术/颅骨切除术、242例缺损修复术、1811例椎板切除术和4560例分流和植入病例，发现复合总体发病率分别为30.2%、38.8%、10.2%、10.2%、10.2%和10.2%。和10.7%。缺损修复的计划外再手术率最高（29.8%）。死亡率范围为0.1%至1.2%。术前呼吸机依赖性是一个显着的预测任何不良事件的所有程序组，而从医院外转移入院是一个显着的预测任何不良事件的所有程序组，除开颅术/cranotomy.CONCLUSIONS NSQIP-儿科，一个大的风险调整的国家数据集的分析，证实围手术期死亡率低，但发病率高的儿科神经外科手术。这些数据提供了对儿科神经外科手术当前预期临床结局的基线了解，确定了收集神经外科特定风险因素和并发症的必要性，并应支持有针对性的QI计划和临床管理干预措施，以改善儿童护理。
OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program Pediatrics (NSQIP-Peds) database platform.METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression.RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy.CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.