Adult Chiari I Malformations: An Analysis of Surgical Risk Factors and Complications Using an International Database

Bhimani, Abhiraj D.; Esfahani, Darian R.; Denyer, Steven; Chiu, Ryan G.; Rosenberg, David M.; Barks, Ashley L; Arnone, Gregory D.; Mehta, Ankit I.

doi:10.1016/j.wneu.2018.04.077

Cited by 38 publications

(23 citation statements)

References 28 publications

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“…There have been various studies that have evaluated additional risk factors and outcomes for patients with CM1. [ 21 22 ] A study by Bhimani et al reviewed an international database of 672 patients and found that obesity, male gender, and the American Society of Anesthesiologists class were predictive of reoperations as well as readmissions. [ 21 ] Furthermore, the authors found that the CSF leak was the most common reason for readmissions.…”

Section: Discussionmentioning

confidence: 99%

“…[ 21 22 ] A study by Bhimani et al reviewed an international database of 672 patients and found that obesity, male gender, and the American Society of Anesthesiologists class were predictive of reoperations as well as readmissions. [ 21 ] Furthermore, the authors found that the CSF leak was the most common reason for readmissions. These factors have been demonstrated across various surgical subspecialties to negatively impact operative outcomes, many of which may not effectively be modified in the short term on hospital admission.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 20 ] Although there are currently various studies evaluating positive and negative predictors for postoperative outcomes, there is currently a paucity of information regarding the effects of point of intervention from diagnosis to index procedure. [ 21 22 ]…”

Section: Introductionmentioning

confidence: 99%

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Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients

Naessig

Kapadia

Para

et al. 2020

J Craniovert Jun Spine

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Background: Chiari malformations (CM) are congenital defects due to hypoplasia of the posterior fossa with cerebellar herniation into the foramen magnum and upper spinal canal. Despite the vast research done on this neurological and structural syndrome, clinical features and management options have not yet conclusively evolved. Quantification of proper treatment planning, can lead to potential perioperative benefits based on diagnoses and days to procedure. This study aims to identify if early operation produces better perioperative outcomes or if there are benefits to delaying CM surgery. Aims and Objective: Assess outcomes for Chiari type I. Methods: The KID database was queried for diagnoses of Chiari Malformation from 2003-2012 by icd9 codes (348.4, 741.0, 742.0, 742.2). Included patients: had complete time to procedure (TTP) data. Patients were stratified into 7 groups by TTP: Same-day as admission (SD), 1-day delay (1D), 2-day delay (2D), 3-day delay (3D), 4-7 days delay (4-7D), 8-14 days delay (8-14D), >14 days delay (>14D). Differences in pre-operative demographics (age/BMI) and perioperative complication rates between patient cohorts were assessed using Pearson's chi-squared tests and T-tests. Surgical details, perioperative complications, length of stay (LOS), total charges, and discharge disposition was compared. Binary logistic regressions determined independent predictors of varying complications (reference: same-day). Results: 13,812 Chiari type I patients were isolated from KID (10.12 ± 6.3, 49.2F%, .063 ± 1.3CCI). CM-1 pts were older (10.12 yrs vs 3.62 yrs) and had a higher Charlson Comorbidity Score (0.62 vs 0.53; all P < 0.05). Procedure rates: 27.8% laminectomy, 28.3% decompression, and 2.2% spinal fusion. CM-1 experienced more complications (61.2% vs 37.9%) with the most common being related to the nervous system (2.8%), anemia (2.4%), acute respiratory distress disorder (2.1%), and dysphagia (1.2%). SD was associated with the low length of stay (5.3 days vs 9.5-25.2 days, P < 0.001), total hospital charges ($70,265.44 vs $90, 945.33-$269, 193.26, P < 0.001) when compared to other TTP groups. Relative to SD, all delay groups had significantly increased odds of developing postoperative complications (1D-OR: 1.29 [1.1- 1.6] → 8-14D-OR: 4.77[3.4-6.6]; all P < 0.05), more specifically, nervous system (1D-OR: 1.8 [1.2-2.5] → 8-14D-OR: 3.3 [1.8-6.2]; all P < 0.05).Sepsis complications were associated with a delay of at least 3D(2.5[1.4-4.6]) while respiratory complications (6.2 [3.1-12.3]) and anemia (2 [1.1-3.5]) were associated with a delay of at least 8-14D (all P < 0.05).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients

Naessig

Kapadia

Para

et al. 2020

J Craniovert Jun Spine

View full text Add to dashboard Cite

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“…The program contains data from over 680 hospitals across at least 14 countries around the world. 9 – 11 Only 2017 data was utilized due to the fact that a new Current Procedural Terminology (CPT) code for endoscopic lumbar decompression—62380—was introduced during that year, allowing us to differentiate between endoscopic and “open” (simple nonendoscopic) approaches, with the latter categorized under the code 63030. 12 Patients whose primary CPT code was either of the 2 aforementioned were included in our study, and separated into endoscopic and nonendoscopic groups accordingly.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events

Chiu

Patel

Zhu

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study and systematic review. Objectives: Endoscopic decompression offers a minimally invasive alternative to traditional, open laminectomy. However, comparison of these surgical techniques has been largely limited to small, single-center studies. In this study, we perform the first international, multicenter comparison of both with regard to their associated rates of mortality, complications, readmissions, and reoperations. Methods: The 2017 American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database, containing data from over 650 hospitals internationally, was queried to evaluate the effect of endoscopic guidance on adverse events. Operative time, length of stay, readmission and reoperation rates, as well as the incidence of peri- and postoperative complications, were compared between endoscopic and open groups. The PubMed/MEDLINE database was queried for studies comparing the techniques. Results: A total of 10 726 single-level lumbar decompression patients were identified and included in this study, 34 (0.32%) of whom were operated upon endoscopically. Apart from 2 (5.88%) readmissions, among which only 1 was unplanned, there were no reported surgical complications within the endoscopic group. The mean length of stay for these patients was 0.86 ± 1.44 days, with procedures lasting an average of 91.89 ± 46.72 minutes. However, these endpoints did not differ significantly from the open group. On literature review, 16 studies met the inclusion criteria, and largely consisted of single-center, retrospective analyses. Conclusions: Endoscopically guided approaches to single-level lumbar decompression did not reduce the incidence of adverse events, length of stay or operative time, perhaps due to advances among certain nonendoscopic techniques, such as microsurgery.

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“…It has been also reported that the PFD is enough with no need of management of dura maters [7][8][9]. Although satisfactory effects had been obtained for separately reported surgeries, some results were contradictory [8][9][10], and there were still some failures for patients undergoing the above surgeries in clinical practice [12][13][14]. In those cases, what were the causes for surgery failures?…”

Section: Pathological Basis and Surgical Failure Causesmentioning

confidence: 99%

The significance of occipitocervical dura angulation in selection of surgery procedures for Chiari malformation type I

Xiu¹,

Zhang²

2019

Journal of Neurorestoratology

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At present, the common surgical procedures for the Chiari malformation type I are comprised of posterior fossa decompression, duraplasty and tonsillectomy. Some neurosurgeons prefer these so called minimally invasive surgeries. However, there are still some failures for patients undergoing the above surgeries in clinical practice. Analyzing causes of many surgical failures, the author put forward the anatomical concept of occipitocervical dura angulation (ODA). The ODA is defined as the included angle between the cerebral dura mater and spinal dura mater at the posterior foramen magnum on the median sagittal plane. For Chiari malformation type I without atlantoaxial instability, the selection of appropriate surgeries and accurate evaluation on the effect of the decompression can be realized after the comprehensive analysis both on the severity of tonsil herniation and the ODA. Tonsillectomy may be needed to add to posterior fossa decompression (PFD) and duraplasty for Chiari malformation type I with the ODA being the larger obtuse angle and/or the tonsil herniation to the level of arcus posterior atlantis.

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Adult Chiari I Malformations: An Analysis of Surgical Risk Factors and Complications Using an International Database

Cited by 38 publications

References 28 publications

Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients

Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients

Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events

The significance of occipitocervical dura angulation in selection of surgery procedures for Chiari malformation type I

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