Timing to surgery of Chiari malformation type 1 affects complication types: An analysis of 13,812 patients

• DOI: 10.4103/jcvjs.jcvjs_67_20
• Publication Date: 2020-08-15T08:21:56Z
• Authors: PeterGust Passias; Sara Naessig; BhaveenH Kapadia; Ashok Para; Waleed Ahmad; Katherine Pierce; Burhan Janjua; Shaleen Vira; Bassel Diebo; Daniel Sciubba
• Keywords: Foramen magnum

Chiari malformations (CM) are congenital defects due to hypoplasia of the posterior fossa with cerebellar herniation into foramen magnum and upper spinal canal. Despite vast research done on this neurological structural syndrome, clinical features management options have not yet conclusively evolved. Quantification proper treatment planning, can lead potential perioperative benefits based diagnoses days procedure. This study aims identify if early operation produces better outcomes or there delaying CM surgery.Assess for type I.The KID database was queried Malformation from 2003-2012 by icd9 codes (348.4, 741.0, 742.0, 742.2). Included patients: had complete time procedure (TTP) data. Patients were stratified 7 groups TTP: Same-day as admission (SD), 1-day delay (1D), 2-day (2D), 3-day (3D), 4-7 (4-7D), 8-14 (8-14D), >14 (>14D). Differences in pre-operative demographics (age/BMI) complication rates between patient cohorts assessed using Pearson's chi-squared tests T-tests. Surgical details, complications, length stay (LOS), total charges, discharge disposition compared. Binary logistic regressions determined independent predictors varying complications (reference: same-day).13,812 I patients isolated (10.12 ± 6.3, 49.2F%, .063 1.3CCI). CM-1 pts older yrs vs 3.62 yrs) a higher Charlson Comorbidity Score (0.62 0.53; all P < 0.05). Procedure rates: 27.8% laminectomy, 28.3% decompression, 2.2% fusion. experienced more (61.2% 37.9%) most common being related nervous system (2.8%), anemia (2.4%), acute respiratory distress disorder (2.1%), dysphagia (1.2%). SD associated low (5.3 9.5-25.2 days, 0.001), hospital charges ($70,265.44 $90, 945.33-$269, 193.26, 0.001) when compared other TTP groups. Relative SD, significantly increased odds developing postoperative (1D-OR: 1.29 [1.1- 1.6] → 8-14D-OR: 4.77[3.4-6.6]; 0.05), specifically, 1.8 [1.2-2.5] 3.3 [1.8-6.2]; 0.05).Sepsis at least 3D(2.5[1.4-4.6]) while (6.2 [3.1-12.3]) (2 [1.1-3.5]) 8-14D (all