Number of surgeries performed during the lifetime of patients with myelomeningocele

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  • 1 Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka;
  • | 2 Department of Neurosurgery, Jikei Medical University, Minato-Ku, Tokyo;
  • | 3 Department of Neurology, Hokkaido University, Sapporo, Hokkaido;
  • | 4 Department of Public Health, Dokkyo Medical University, Mibu, Tochigi; and
  • | 5 National Hospital Organization, Matsue Medical Center, Matsue, Shimane, Japan
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OBJECTIVE

Patients with myelomeningocele often require multiple surgeries, but no study has clarified the kind of treatment given to these patients throughout their lives. The authors analyzed the type of surgery that was performed and at what age for Japanese patients with myelomeningoceles.

METHODS

The Japanese health claims data of 556 patients with myelomeningocele for the period from January 2005 to March 2020 provided by the Japan Medical Data Center Co., Ltd., were examined to investigate the number of surgeries performed and the patient age at surgery for each specialty. The patients were divided into two groups (those ≤ 18 years old [group A] and those > 18 years old [group B]), and the way in which the types of surgery and the percentage of surgeries changed between these two groups was examined.

RESULTS

The mean follow-up period was 4.4 years. The mean age at the end of the overall follow-up was 18.6 years (range 0–70.5 years), and 1033 surgeries were performed on 294 patients (0.42 surgeries performed per patient per year) during this period. The number of surgeries for patients in group A was 818 in 192 patients, with 0.62 surgeries per patient per year, and for patients in group B it was 215 in 102 patients, with 0.19 surgeries per patient per year. The number of surgeries and the mean age at the time of surgery were as follows: 313 neurosurgeries, 5.16 years; 280 orthopedic surgeries, 11.36 years; 70 urological surgeries, 14.57 years; and 202 dermatological/plastic surgeries, 16.19 years. In the surgeries related to myelomeningocele, the rates of CSF shunt placement, tethered cord release, muscle and tendon surgery, and other bone and joint surgery decreased significantly in group B, but they continued to undergo these surgeries. In group B, the rates of skin surgery, nephrostomy, ureterostomy, and cystostomy were significantly higher.

CONCLUSIONS

A significant number of surgeries in multiple specialties related to myelomeningocele continue to be performed in adulthood, indicating that these patients require continuous care throughout their lives.

ABBREVIATIONS

ACE = antegrade continence enema; ETV = endoscopic third ventriculostomy; EVD = external ventricular drainage; JMDC = Japan Medical Data Center; NTD = neural tube defect; SB = spina bifida.

Diagram from Behbahani et al. (pp 488–496).

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