Sudhakar Vadivelu1, Ahilan Sivaganesan2, Akash J Patel2, Satish Agadi3, Robert J Schmidt3, Prasitha Mani3, Andrew Jea4. 1. Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA; Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 2. Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. 3. Division of Neurophysiology, Texas Children's Hospital, Houston, Texas, USA; Department of Neurology, Baylor College of Medicine, Houston, Texas, USA. 4. Neuro-Spine Program, Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA. Electronic address: ajea@bcm.edu.
Abstract
OBJECTIVE: Higher benchmarks in safety for patients undergoing neurosurgery have been introduced. With these principles, new tools and techniques were established, including intraoperative neurophysiological monitoring (IONM). Current trends as a function of patient-, surgeon-, and procedure-related factors and complication rates in the utilization of IONM as an adjunct to the practice of pediatric neurosurgery have not been investigated previously. METHODS: Between 2008 and 2011, 4467 neurosurgical procedures were performed on 2352 patients at Texas Children's Hospital. A retrospective chart review was performed in which surgeon, procedure, and patient characteristics, as well as perioperative complications, were recorded for IONM and non-IONM cases. RESULTS: Neurosurgical procedures performed with IONM steadily increased. Surgeon-related factors associated with IONM use included surgeons with <10 years of practice (P < .0001), and subspecialty interest in spine (P < .0001) and oncology (P = .0048). Procedure-related factors associated with IONM use included operations involving the spinal cord (P < .0001). Patient-related factors associated with IONM use included children older than 3 years of age and with increased American Society of Anesthesiologists score (P < .0001). The neurological complication rate in the IONM cohort (range 3.4% to 11.3%; mean 6.4%) was significantly higher compared to the non-IONM cohort (range 1.1% to 1.8%; mean 1.5%) (P < .0001). CONCLUSIONS: The percent of procedures performed with IONM increased. However, these trends do not seem governed by improvement to patient outcomes because the complication rates were higher in the IONM cohort than the non-IONM cohort.
OBJECTIVE: Higher benchmarks in safety for patients undergoing neurosurgery have been introduced. With these principles, new tools and techniques were established, including intraoperative neurophysiological monitoring (IONM). Current trends as a function of patient-, surgeon-, and procedure-related factors and complication rates in the utilization of IONM as an adjunct to the practice of pediatric neurosurgery have not been investigated previously. METHODS: Between 2008 and 2011, 4467 neurosurgical procedures were performed on 2352 patients at Texas Children's Hospital. A retrospective chart review was performed in which surgeon, procedure, and patient characteristics, as well as perioperative complications, were recorded for IONM and non-IONM cases. RESULTS: Neurosurgical procedures performed with IONM steadily increased. Surgeon-related factors associated with IONM use included surgeons with <10 years of practice (P < .0001), and subspecialty interest in spine (P < .0001) and oncology (P = .0048). Procedure-related factors associated with IONM use included operations involving the spinal cord (P < .0001). Patient-related factors associated with IONM use included children older than 3 years of age and with increased American Society of Anesthesiologists score (P < .0001). The neurological complication rate in the IONM cohort (range 3.4% to 11.3%; mean 6.4%) was significantly higher compared to the non-IONM cohort (range 1.1% to 1.8%; mean 1.5%) (P < .0001). CONCLUSIONS: The percent of procedures performed with IONM increased. However, these trends do not seem governed by improvement to patient outcomes because the complication rates were higher in the IONM cohort than the non-IONM cohort.
Authors: Remi M Ajiboye; Howard Y Park; Jeremiah R Cohen; Evan E Vellios; Elizabeth L Lord; Adedayo O Ashana; Zorica Buser; Jeffrey C Wang Journal: Int J Spine Surg Date: 2018-08-15
Authors: Luc Joyeux; Marjolijn Deprez; Ahmad Khatoun; Kris Van Kuyck; Kelly Pelsmaekers; Alexander C Engels; Hongmei Wang; Marina Gabriela Monteiro Carvalho Mori da Cunha; Stephanie De Vleeschauwer; Myles Mc Laughlin; Jan Deprest Journal: Sci Rep Date: 2017-11-23 Impact factor: 4.379
Authors: Remi M Ajiboye; Howard Y Park; Jeremiah R Cohen; Evan E Vellios; Elizabeth L Lord; Adedayo O Ashana; Zorica Buser; Jeffrey C Wang Journal: Int J Spine Surg Date: 2017-12-05