Prospective surveillance of complications in a pediatric neurosurgery unit

Drake, James M.; Riva-Cambrin, Jay; Jea, Andrew; Auguste, Kurtis I.; Tamber, Mandeep S.; Lamberti-Pasculli, Maria

doi:10.3171/2010.1.peds09305

Cited by 49 publications

(44 citation statements)

References 23 publications

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“…In the Toronto series, 64% of AEs required a second procedure, whereas in our series 52% of AEs required a second procedure. The overall unplanned 30-day RTOR in our series was 10.5% and that in the Toronto series was 10.4%, 5 whereas this rate was 17% in a British single pediatric neurosurgery institution series. 15 In the latter series, the unplanned reoperation rate increased to 28% during the 2-year follow-up study period.…”

Section: Comparison Of Pediatric Neurosurgery Complication Ratesmentioning

confidence: 74%

“…The pediatric neurosurgical department at the SickKids hospital in Toronto reported an overall CR of 16.4% (data were also prospectively collected). 5 The CRs in diagnostic subgroups were also comparable, but further differentiated comparison is difficult because of differences in classification. In the Toronto series, 64% of AEs required a second procedure, whereas in our series 52% of AEs required a second procedure.…”

Section: Comparison Of Pediatric Neurosurgery Complication Ratesmentioning

confidence: 96%

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

Lindert

Delye

Leonardo

2014

PED

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Object 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. Methods 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. Results 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. Conclusions 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).

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Section: Comparison Of Pediatric Neurosurgery Complication Ratesmentioning

confidence: 74%

Section: Comparison Of Pediatric Neurosurgery Complication Ratesmentioning

confidence: 96%

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

Lindert

Delye

Leonardo

2014

PED

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“…Reviewing a surgical unit as a whole instead of by surgeon or by service line enabled commonalities to emerge. 11 In addition, surgeons who perform a procedure rarely may learn from complications and reoperations made by surgeons who perform the procedure often. Although reviewing a department's reoperation data is an important first step, characterizing reoperations in itself does not result in qualitatively improved outcome.…”

Section: Opportunities For Quality Improvementmentioning

confidence: 99%

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

McLaughlin

Jin

Martin

2015

JNS

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By the nature of the underlying conditions and the corrective procedure, surgical patients are exposed to a variety of risks. Despite oftentimes relatively low complication rates, the median incidence of inpatient adverse events has been estimated at 9%-10%, with operation-related events constituting almost 40% of those events, across all surgical specialties within an institution. 8,14 Across surgical specialties, multiple prospective and retrospective studies have reported best-case scenario outcomes and complication rates specific to particular entities and procedures. 25 Importantly, neurosurgery has relatively high morbidity and mortality rates in comparison with other surgical specialties. 15 Review of morbidities and mortality has been the primary method of assessing surgical quality used by physicians, hospitals, and oversight agencies. 10,17,20 In recent years, the reoperation rate, defined as the percentage of patients undergoing a new operation, has been proposed as a quality indicator, a surrogate for surgical adverse events. 4,13,19,24 General surgery has been at the forefront of assessing reoperations. Reported rates have varied widely (0.6% to 9.4%) depending on the definition, method of detection, case selection criteria, heterogeneity of practices, and difference in department and hospital practic- OBJect Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery. methOdS All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated. reSultS The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days. cONcluSiONS This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement in...

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“…As reported by Peretta and colleagues, the overall complication rate for such operative procedures is roughly 7.3 %, with CSF leaks, aborted procedures, and intraventricular hemorrhages reported as the most common causes of morbidity [49]. A number of other reported complications, albeit far more rare, include subdural hygromas, wound infections, and endocrine disturbances [48][49][50][51][52]. Regarding associated endocrine dysfunction secondary to intraoperative manipulation, the precise mechanism remains unknown, but possible involvement of the tuber cinereum, a component of the hypothalamic-pituitary axis, is implicated [53].…”

Section: Complicationsmentioning

confidence: 94%

Ventricular endoscopy in the pediatric population: review of indications

et al. 2014

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Introduction Neuroendoscopy has greatly impacted pediatric neurosurgery over the past few decades. Improved optics and microsurgical tools have allowed neuroendoscopes to be used for a multitude of neurosurgical procedures. Discussion In this review article, we present the breadth of intraventricular neuroendoscopic procedures for the treatment of conditions ranging from hydrocephalus and brain tumors to congenital cysts and other pathologies. We critically discuss treatment indications and reported success rates for neuroendoscopic procedures. We also present novel approaches, technical nuances, and variations from recently published literature and as practiced in the authors' institution.

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Prospective surveillance of complications in a pediatric neurosurgery unit

Cited by 49 publications

References 23 publications

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

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

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

Ventricular endoscopy in the pediatric population: review of indications

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