Pediatric tethered cord release: an epidemiological and postoperative complication analysis.
Pediatric tethered cord release: an epidemiological and postoperative complication analysis.
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DOI：
10.21037/jss.2019.09.02
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发表时间：
2019-09-01
期刊：
影响因子：
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通讯作者：
Mehta, Ankit I
中科院分区：
文献类型：
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作者：
Bhimani, Abhiraj D;Selner, Ashley N;Mehta, Ankit I
背景：系绳松解术（TCR）是儿科神经外科的一种常见手术。尽管有相对安全的名声，但术后并发症的危险因素却知之甚少。方法：在本研究中，通过单因素和多因素分析，对美国外科医师学会-国家外科质量改进计划儿科数据库（ACS-NSQIP-P）进行回顾，以确定系带松解术的人口统计学、危险因素和术后30天并发症。并对再入院和再手术的原因进行了详细的分析。结果：研究了三千六百八十二例儿科患者。接受TCR的男性更年轻（5.6岁对6.1岁），术前合并症发生率更高，但30天并发症发生率低于女性。后来出现并发症的患者更有可能需要术中显微镜，手术时间更长，术前美国麻醉医师协会（ASA）等级较差。结论：尽管TCR是一种相对安全的手术，但在儿科人群中TCR的并发症风险有限。在这项大型的国际数据库研究中，发现男性在TCR之前有更多的危险因素，而女性出现术后并发症的风险更高。本文提供了多机构接受TCR的儿科患者的大样本，可以作为未来研究的当代“快照”。
BACKGROUND: Tethered cord release (TCR) is a common procedure in pediatric neurosurgery. Despite a reputation for being relatively safe, the risk factors for postoperative complications are poorly understood.METHODS: In this study, the American College of Surgeons-National Surgical Quality Improvement Program Pediatric Database (ACS-NSQIP-P) was reviewed to identify the demographics, risk factors, and 30-day postoperative complications for tethered cord release using univariate and multivariate analysis. A detailed analysis of reasons for readmission and reoperation was also performed.RESULTS: Three thousand and six hundred eighty-two pediatric patients were studied. Males undergoing TCR were younger (5.6 vs. 6.1 years) and had a higher rate of pre-operative comorbidities but lower 30-day complication rate versus females. Patients who later developed complications were more likely to require a microscope intraoperatively, had longer operative times, and worse preoperative American Society of Anesthesiologists (ASA) class.CONCLUSIONS: Despite being a relatively safe procedure, TCR in the pediatric population carries a finite risk of complications. In this large, international database study, males were found to have a greater number of risk factors prior to TCR, while females exhibit a higher risk of developing postoperative complications. This paper provides a large sample size of multi institutional pediatric patients undergoing TCR and may serve as a contemporary "snapshot" for future studies.