Medical Student Carle Illinois College of Medicine, Minnesota, United States
Introduction: One of the larger subsections of meeting global neurosurgical demand is pediatric neurosurgery, which is associated with high morbidity and mortality in low-middle-income countries (LMICs). We sought to analyze trends in procedures and complications over time for a high-volume pediatric neurosurgical practice in an LMIC.
Methods: Charts from 2007 through 2013 were meticulously digitized, with demographic information of the patient, including age and baseline neurological presentation, procedure, and complications, including re-operation and death. In some patients, length of stay and cost was also available. Outcomes of interest included major complications, a composite outcome of reoperation, and death. A subgroup analysis of shunts and shunt-related complications was also performed. Multivariate regression was used to ascertain a correlation between the primary outcome and associated variables.
Results: Data on 973 patients were obtained from 2007 – 2013. Of those cases, 582 were ventriculoperitoneal shunts. Re-operation periods across the full period were 20.9%, and mortality was 6.4%. After VP shunt placement, spina bifida reconstruction was the second most common procedure done in the population (19.3% of cases). While total cases continued to rise, major complications were reduced significantly after 2010. On linear regression, each additional year was associated with a 3.2% reduction in major complications. Reduction in complications was also associated with an increase in cost over time (p = 0.0087).
Conclusion : We show in our analysis how complications over time have decreased in this high-volume pediatric practice in Tanzania, an LMIC. Specifically for shunts, each year, a covariate-adjusted reduction of 3.2% was observed. Notably, though, increased mean cost over time was also observed, suggesting an expansion of the cost of care for pediatric populations.
