Postoperative outcome of children with neural tube defects and craniocervical decompression surgery: risk factors with regard to complications and length of hospitalisation

Background: In Germany approx. 800 newborns with neural tube defect deserve primary surgical care every year. Oftentimes followed by further operations due to secondary problems during their clinical course. To date, there is little knowledge with respect to risk factors for an unfavorable postoperative course.

To investigate the impact of age, diagnosis, history of preceding surgery and various perioperative variables we analyzed the correlation of these variables with postoperative complications and clinical course.

Patients and methods: Retrospective cohort trial on 102 children with Spina bifida and Arnold Chiari II malformation in which craniocervical decompression (CCD) was carried out 1995 to 2004 (partly complemented by coverage of a cele, myelolysis or implantation of a shunt).

Analyzed risk factors included age, diagnosis, previous surgeries and current intervention, as well as intra-and perioperative variables. Outcome was defined as duration of ventilation, length of stay (LOS), postoperative seizures or sepsis. After descriptive analysis potential risk factors for unfavorable outcome were identified by correlation analysis and checked for significance by regression analysis.

Results: 102 children of 0–19 years (mean: 6.1, SD 4.8); 2.4 (SD 1.1) previous surgeries. 56 children received only CCD, 46 had additional procedures like shunt implantation (n=6), coverage of a cele (n=9) or myelolysis (n=31).

Mean duration of surgery was 121min (SD 32) and was significantly correlated with circulatory dysregulation (p=0.03). Mean duration of ventilation was 14.8 (SD 17). An additional shunt implantation was significantly correlated with longer ventilator support (p<0.001) or the need for reintubation (p<0.002).

Younger children stayed significantly longer on the intensive care unit (p=0.005); older children were significantly more likely to display postoperative seizures (p=0.01).

For the appearance of an infection no significant correlation with the reviewed variables was found with the exception of certain preceding surgeries (status post myelolysis: p=0.01, status post shunt-implantation: p<0.08).

Conclusion: Our analyses showed, that the age at surgery, duration of surgery and ventilation along with previous operations are relevant risk factors relating to the postoperative course.