Myelomeningocele: surgical trends and predictors of outcome in the United States, 1988–2010

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Myelomeningocele repair is an uncommonly performed surgical procedure. The volume of operations has been decreasing in the past 2 decades, probably as the result of public health initiatives for folate supplementation. Because of the rarity of myelomeningocele, data on patient or hospital factors that may be associated with outcome are scarce. To determine these factors, the authors investigated the trends in myelomeningocele surgical repair in the United States over a 23-year period and examined patient and hospital characteristics that were associated with outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The Nationwide Inpatient Sample database for 1988–2010 was queried for hospital admissions for myelomeningocele repair. This database reports patient, hospital, and admission characteristics and surgical trends. The authors used univariate and multivariate logistic regression to assess associations between patient and hospital characteristics and in-hospital deaths, nonroutine discharge, long hospital stay, and shunt placement.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>There were 4034 hospitalizations for surgical repair of myelomeningocele. The annual volume decreased since 1988 but plateaued in the last 4 years of the study. The percentages of myelomeningocele patients with low income (30.8%) and Medicaid insurance (48.2%) were disproportionately lower than those for the overall live-born population (p &lt; 0.0001). More operations per 10,000 live births were performed for Hispanic patients (3.2) than for white (2.0) or black (1.5) patients (p &lt; 0.0001). Overall, 56.6% of patients required shunt placement during the same hospital stay as for surgical repair; 95.0% of patients were routinely discharged; and the in-hospital mortality rate was 1.4%. Nonwhite race was associated with increased in-hospital risk for death (OR 2.8, 95% CI 1.2–6.3) independent of socioeconomic or insurance status.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Overall, the annual surgical volume of myelomeningocele repairs decreased after public health initiatives were introduced but has more recently plateaued. The most disproportionately represented populations are Hispanic, low-income, and Medicaid patients. Among nonwhite patients, increased risk for in-hospital death may represent a disparity in care or a difference in disease severity.</jats:p></jats:sec>

The Use of External Ventricular Drainage to Reduce the Frequency of Wound Complications in Myelomeningocele Closure

“…This is consistent with the extant literature on outcomes following MMC repair [1,6]. Due to the morbidity associated with shunting, efforts have been made to reduce the need for this procedure.…”

“…Surgical closure is required within 72 h of birth to protect the neural elements and cerebrospinal fluid (CSF) from infection [5]. Eighty to 90% of patients with MMC have historically required permanent CSF diversion for treatment of hydrocephalus [1,[6][7][8]. This number has been reduced in the recent past through the acceptance of macrocephaly and ventriculomegaly in the absence of symptoms of hydrocephalus or Chiari II malformation; whether there are negative consequences to this higher shunting threshold remains to be seen [9,10] Up to 18% of patients experience wound complications, including dehiscence, pseudomeningocele formation, CSF leak, and infection, that have negative effects on outcomes and significantly increase the length of hospital stay [1].…”

Urologic self-management through intermittent self-catheterization among individuals with spina bifida: A journey to self-efficacy and autonomy

“…In this US cohort, Hispanic ethnicity was associated with a lower incidence of surgically created channel use, which may reflect a cultural preference for a non-invasive approach or a disparity in access to surgical care. As Hispanics are the greatest population in need of myelomeningocele surgical repair in the US and concurrently have a higher urinary incontinence rate and lower satisfaction with bladder management [18,19], these findings are relevant to the management of this growing population within our nation. Overall, the average age of ISC emerges as a target for culturally-appropriate educational interventions to stimulate earlier self-management.…”

Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis

“…Studies seeking to investigate relatively rare pediatric diseases or conditions would be relevant applications of big data as these inquiries would be supported by much larger sample sizes than are obtainable by individual centers. Notable examples of such studies include wartime head injury, myelomeningocele, cerebral aneurysms, and venous thromboembolism in children with traumatic brain injury [40-44]. Big data can provide information on the associations of hospital type, provider caseload, and geography with outcomes, as has been nicely done for pediatric brain tumors, shunt surgery, and cerebrovascular pathology [37, 38, 45].…”