Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program–Pediatrics

Kuo, Benjamin Jyhhan; Vissoci, João Ricardo Nickenig; Egger, Joseph; Smith, Emily R.; Grant, Gerald A.; Haglund, Michael M.; Rice, Henry E.

doi:10.3171/2016.10.peds16414

Cited by 25 publications

(12 citation statements)

References 18 publications

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“…We found a total of 464 ESs with an average of 10 per publication, with some papers reporting ≥20 [24, 30-32]. Virtually all reported ESs were the result of non-hypothesis-driven exploratory analysis.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…NSQIP-P is a multiinstitutional pediatric (age < 18 years) surgical outcomes database containing preoperative, surgical, and 30-day outcome variables collected based on a systematic sampling process to ensure proportional diversity in selection using an 8-day sampling cycle from more than 60 pediatric institutions. 19 NSQIP-P data are continuously audited and validated and are compiled into Participant User Files (PUFs) for use in quality improvement and surgical outcomes research. The 2014-2015 NSQIP-P PUF was used for this study.…”

Section: Methodsmentioning

confidence: 99%

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Shaw

Fletcher

Devito

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe aim of this study was to evaluate the effect of postoperative admission status on 30-day perioperative complications in patients with growing spinal instrumentation undergoing surgical lengthening.METHODSThis retrospective case-control study of records from the 2014–2015 National Surgical Quality Improvement Program–Pediatric database was performed to identify surgical lengthening procedures of spinal implants in patients with growing instrumentation by Current Procedural Terminology code. The 30-day postoperative complications were classified according to the Clavien-Dindo system. Patients were subdivided according to their postsurgical admission status. Admission status, American Society of Anesthesiologists (ASA) Physical Status classification, tracheostomy, neuromuscular diagnosis, ventilator dependence, and nutritional support were considered as possible risk factors in univariate and multivariate logistic regression analyses.RESULTSA total of 796 patients were identified (mean age 9.09 ± 3.44 years; 54% of patients were female), of whom 73% underwent lengthening on an inpatient basis. Patients with a tracheostomy or ventilator dependence were more likely to be admitted postoperatively. The overall rate of major complications was 3.5% and did not differ based on admission status (2.8% inpatient vs 3.8% outpatient, p = 0.517). On univariate analysis, ventilator dependence (9.5% vs 2.7%, p = 0.002), need for nutritional support (7.1% vs 2.5%, p = 0.006), and ASA class > II (4.8% vs 1.3%, p = 0.04) placed patients at a higher risk for any postoperative complications. Multivariate analysis identified only ventilator dependence as an independent risk factor for any perioperative complication.CONCLUSIONSPostoperative admission status did not affect the rate of 30-day perioperative complications, readmission, or rate of unplanned operations following lengthening of growing spinal instrumentation. Outpatient lengthening appears to be safe; however, consideration for postoperative admission should be given for those who are ventilator dependent.

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“…The American College of Surgeons developed the National Surgical Quality Improvement Program‐Pediatric (NSQIP‐P) to pool data for analysis and ultimately improve surgical outcomes . NSQIP‐P has been widely used to better understand perioperative complications and safety outcomes in general surgery, neurosurgery, and otolaryngologic procedures in children . This study aims to use the multi‐institutional NSQIP‐P database to define patient demographics, surgical characteristics, and postoperative complications in children undergoing rhinoplasty, and identify predictive factors for adverse events.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 NSQIP-P has been widely used to better understand perioperative complications and safety outcomes in general surgery, neurosurgery, and otolaryngologic procedures in children. [13][14][15][16][17][18] This study aims to use the multi-institutional NSQIP-P database to define patient demographics, surgical characteristics, and postoperative complications in children undergoing rhinoplasty, and identify predictive factors for adverse events. Due to the uncertainty of the ideal age of procedure, we stratified analyses by child age to further understand the effect of age on risk factors and complications.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Rhinoplasty: A national surgical quality improvement program analysis

2018

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Objectives Rhinoplasty is commonly performed in children with congenital anomalies and resultant nasal deformity causing airway obstruction. Little is known regarding patient factors or perioperative sequelae. We define demographic characteristics and perioperative complications for children undergoing rhinoplasty within a large national cohort. Study Design Retrospective cohort study of children aged ≤ 18 years undergoing rhinoplasty utilizing data from the 2012 to 2015 American College of Surgeons National Surgery Quality Improvement Program‐Pediatric public use file. Methods All children who underwent rhinoplasty were identified. Postoperative complications were defined as 30‐day postoperative infection, unplanned readmission and reoperation, and death. Multivariate logistic regression was used to identify predictors of complications. Subgroup analysis was performed based on child age (age < 5 years vs. 5–13 years vs. ≥ 14 years). Results Of 1,378 children undergoing rhinoplasty, 21(1.52%) children experienced complications, with the most common being unplanned readmission. Younger children were more likely to experience complications (3.79% aged < 5 years vs. 0.66% aged ≥ 14 years; P = 0.001). Using multivariate logistic regression analysis, we observed a 61% decreased odds of complication with each age group (odds ratio 0.39, 95% confidence interval 0.19, 0.77; P = 0.007). Younger children were more likely to be male (56.2% male aged < 5 years vs. 46.6% male aged ≥ 14 years; P = 0.011), have developmental delay (11.7% aged < 5 years vs. 3.65% aged ≥ 14 years; P < 0.001), and have craniofacial abnormalities (73.2% aged < 5 years vs. 42.1% aged ≥ 14 years; P < 0.001). Conclusion Children undergoing rhinoplasty experience few major complications, with the most common being unplanned readmission. Younger children are at greater risk and are more likely to be male with craniofacial abnormalities. Level of Evidence 4 Laryngoscope, 129:494–499, 2019

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Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program–Pediatrics

Cited by 25 publications

References 18 publications

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

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

Complications following lengthening of spinal growing implants: is postoperative admission necessary?

Pediatric Rhinoplasty: A national surgical quality improvement program analysis

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