Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).</jats:p></jats:sec>

Intraoperative complications in pediatric neurosurgery: review of 1807 cases

“…This shortcoming hampers comparison of outcome data among different centers and therapies over time. 25 Even an apparently simple complication, such as surgical wound infection, was found to have 41 different definitions and 13 different surgical grading scales in 82 studies. 7 In addition, an event may be a complication in a specific procedure, but not in another, and multiple complications may be difficult to classify correctly, unless the complications are fully independent and not part of the same chain of events.…”

“…7 In addition, an event may be a complication in a specific procedure, but not in another, and multiple complications may be difficult to classify correctly, unless the complications are fully independent and not part of the same chain of events. 25 At least it can be agreed that an adverse event is characterized as untoward, undesirable, or detrimental; having an impact on the patient; and being caused by a health care process rather than the natural course of the disease. 7 We defined a complication as "any adverse event," but this is not a clear-cut definition and quite often is relatively arbitrary.…”

“…11 Our previous study on pediatric neurosurgical complications occurring within 30 days of surgery in a series of 1000 procedures was the first to mention intraoperative complications separately, including anesthesiological complications. 25 In addition, many intraoperative surgical complications may require the anesthesiologist to intervene, whereas anesthesiological complications may be a reason to postpone or abort surgery. Therefore, we see good reasons to draw extra attention to complications occurring intraoperatively.…”

“…Third, the special attention that is given to a group of patients under study may result in a lower complication rate, whereas at the same time, complications may be underestimated in patients undergoing routine procedures at the same institution. 25 We did not try to look into differences between pediatric and adult neurosurgeons with respect to IOCs. First, the number of IOCs is so low that significant comparison is not possible with these numbers in the subgroups.…”

Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures

“…27 All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included and gathered in a new database in SPSS (IBM SPSS Statistics for Windows, Version 22.0). Variables that were analyzed were as follows: demographic data, type of procedure, intraoperative complications (IOCs) and postoperative complications (POCs), postoperative hemoglobin level, and transfusion rate.…”