Trends in surgical treatment of Chiari malformation Type I in the United States

D. Andrew Wilkinson Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan

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Kyle Johnson Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan

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Hugh J. L. Garton Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan

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Karin M. Muraszko Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan

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Cormac O. Maher Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan

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OBJECTIVE

The goal of this analysis was to define temporal and geographic trends in the surgical treatment of Chiari malformation Type I (CM-I) in a large, privately insured health care network.

METHODS

The authors examined de-identified insurance claims data from a large, privately insured health care network of over 58 million beneficiaries throughout the United States for the period between 2001 and 2014 for all patients undergoing surgical treatment of CM-I. Using a combination of International Classification of Diseases (ICD) diagnosis codes and Current Procedural Terminology (CPT) codes, the authors identified CM-I and associated diagnoses and procedures over a 14-year period, highlighting temporal and geographic trends in the performance of CM-I decompression (CMD) surgery as well as commonly associated procedures.

RESULTS

There were 2434 surgical procedures performed for CMD among the beneficiaries during the 14-year interval; 34% were performed in patients younger than 20 years of age. The rate of CMD increased 51% from the first half to the second half of the study period among younger patients (p < 0.001) and increased 28% among adult patients between 20 and 65 years of age (p < 0.001). A large sex difference was noted among adult patients; 78% of adult patients undergoing CMD were female compared with only 53% of the children. Pediatric patients undergoing CMD were more likely to be white with a higher household net worth. Regional variability was identified among rates of CMD as well. The average annual rate of surgery ranged from 0.8 surgeries per 100,000 insured person-years in the Pacific census division to 2.0 surgeries per 100,000 insured person-years in the East South Central census division.

CONCLUSIONS

Analysis of a large nationwide health care network showed recently increasing rates of CMD in children and adults over the past 14 years.

ABBREVIATIONS

CM-I = Chiari malformation Type I; CMD = CM-I decompression; CPT = Current Procedural Terminology; ICD-9-CM = International Classification of Diseases, 9th edition, Clinical Modification.
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