Complication rates following Chiari malformation surgical management for Arnold–Chiari type I based on surgical variables: A national perspective
Peter G Passias1, Sara Naessig1, Ashok Para1, Waleed Ahmad1, Katherine Pierce1, M Burhan Janjua1, Shaleen Vira2, Daniel Sciubba3, Bassel Diebo4
1 Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
2 Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
3 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
4 Department of Orthopaedic Surgery, Suny Downstate, New York, NY, USA
Peter G Passias
Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, 301 East 17th Street, New York 10003, NY
Source of Support: None, Conflict of Interest: None
Introduction: This study aimed to identify complication trends of Chiari Malformation Type 1 patients (CM-1) for certain procedures and concomitant diagnoses on a national level.
and Methods: The Kids' Inpatient Database was queried for diagnoses of operative CM-1 by International Classification of Disease-9 codes (348.4). Differences in preoperative demographics and perioperative complication rates between patient cohorts were assessed using Pearson's Chi-squared test and t-test when necessary. Binary logistic regression was utilized to find significant factors associated with complication rate. Certain surgical procedures were analyzed for their relationship with postoperative outcomes.
Results: Thirteen thousand eight hundred and twelve CM-1 patients were identified with 8.2% suffering from a complication. From 2003 to 2012, the rate of complications for CM-1 pts decreased significantly (9.6%–5.1%) along with surgical rate (33.3%–28.6%), despite the increase in CM-1 diagnosis (36.3%–42.3%; all P < 0.05). CM-1 pts who had a complication were younger and had a lower invasiveness score; however, they had a larger Charlson Comorbidity Index than those who did not have a complication (all P < 0.05). CM-1 pts who experienced complications had a concurrent diagnosis of syringomyelia (7.1%), and also scoliosis (3.2%; all P < 0.05). CM-1 pts who did not have a complication had a greater rate of operation than those that had a complication (76.4% vs. 23.6% P < 0.05). The most common complications were nervous system related (2.8%), anemia (2.4%), and acute respiratory distress (2.1%). CM-1 pts that underwent an instrumented fusion (3.4% vs. 2.1%) had a greater complication rate as well as compared to those who underwent a craniotomy (23.2% vs. 19.1%; all P < 0.05). However, CM-1 pts that underwent a decompression had lower postoperative complications (21.3% vs. 28.9%; all P < 0.05).
Conclusions: Chiari patients undergoing craniectomies as well as instrumented fusions are at a higher risk of postoperative complications especially when the instrumented fusions were performed on >4 levels.