Prospective surveillance of complications in a pediatric neurosurgery unit

Clinical article

James M. Drake F.R.C.S.C.1, Jay Riva-Cambrin M.D., M.Sc.2, Andrew Jea M.D.3, Kurtis Auguste M.D.4,5, Mandeep Tamber F.R.C.S.C.6, and Maria Lamberti-Pasculli R.N.1
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  • 1 Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada;
  • | 2 Division of Pediatric Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah;
  • | 3 Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas;
  • | 4 Department of Neurosurgery, Children's Hospital, University of California, San Francisco, and
  • | 5 Division of Neurosurgery, Children's Hospital, Oakland, California; and
  • | 6 Pediatric Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Object

Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement.

Methods

The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events.

Results

There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision.

Conclusions

Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

Abbreviations used in this paper:

ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; ICP = intracranial pressure.

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