Consensus definitions of complications for accurate recording and comparisons of surgical outcomes in pediatric neurosurgery

Clinical article

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Object

Monitoring and recording of complications in pediatric neurosurgery are important for quality assurance and in particular for improving outcomes. Lack of accurate or mutually agreed upon definitions hampers this process and makes comparisons between centers, which is an important method to improve outcomes, difficult. Therefore, the Canadian Pediatric Neurosurgery Study Group created definitions of complications in pediatric neurosurgery with consensus among 13 Canadian pediatric neurosurgical centers.

Methods

Definitions of complications were extracted from randomized trials, prospective data collection studies, and the medical literature. The definitions were presented at an annual meeting and were subsequently recirculated for anonymous comment and revision, assembled by a third party, and re-presented to the group for consensus.

Results

Widely used definitions of shunt failure were extracted from previous randomized trials and prospective studies. Definitions for wound infections were extracted from the definitions from the Centers for Disease Control and Prevention. Postoperative neurological deficits were based on the Pediatric Stroke Outcome Measure. Other definitions were created and modified by consensus. These definitions are now currently in use across the Canadian Pediatric Neurosurgery Study Group centers in Morbidity and Mortality data collection and for subsequent comparison studies.

Conclusions

Coming up with consensus definitions of complications in pediatric neurosurgery is a first step in improving the quality of outcomes. It is a dynamic process, and further refinements are anticipated. Center to center comparison will hopefully allow significant variations in outcomes to be identified and acted upon.

Abbreviations used in this paper:CDC = Centers for Disease Control and Prevention; CPNSG = Canadian Pediatric Neurosurgery Study Group; ICP = intracranial pressure.

Article Information

Address correspondence to: James M. Drake, F.R.C.S.C., Division of Neurosurgery, Suite 1504, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. email: james.drake@sickkids.ca.

Please include this information when citing this paper: published online June 22, 2012; DOI: 10.3171/2012.3.PEDS11233.

© AANS, except where prohibited by US copyright law.

Headings

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