BENEFIT OF NEUROPHYSIOLOGIC MONITORING FOR PEDIATRIC CARDIAC-SURGERY

Background. Pediatric patients undergoing repair of congenital cardiac approved by the institutional review board, electroencephalography, t ranscranial Doppler ultrasonic measurement of middle cerebral artery b lood flow velocity, and transcranial near-infrared cerebral oximetry w ere monitored in 250 patients, An interventional algorithm was used to detect and correct specific deficiencies in cerebral perfusion or oxy genation or to increase cerebral tolerance to ischemia or hypoxia. Res ults: Noteworthy changes in brain perfusion or metabolism were observe d in 176 of 250 (70%) patients, Intervention that altered patient mana gement was initially deemed appropriate in 130 of 176 (74%) patients w ith neurophysiologic changes, Obvious neurologic sequelae (i.e., seizu re, movement, vision or speech disorder) occurred in five of 74 (7%) p atients without noteworthy change, seven of 130 (6%) patients with int ervention, and 12 of 46 (26%) patients without intervention (p = 0.001 ), Survivors' median length of stay was 6 days in the no-change and in tervention groups but 9 days in the no-intervention group, In addition , the percentage of patients in the no-intervention group discharged f rom the hospital within 1 week (32%) was significantly less than that in either the intervention (51%, p = 0.05) or no-change (58%, p = 0.01 ) groups, On the basis of an estimated hospital neurologic complicatio n cost of $1500 per day, break-even analysis justified a hospital expe nditure for neurophysiologic monitoring of $2142 per case, Conclusions : Interventions based on neurophysiologic monitoring appear to decreas e the incidence of postoperative neurologic sequelae and reduce the le ngth of stay, Inasmuch as the break-even cost for neurophysiologic mon itoring is more than four times the actual average charge, both patien ts and hospital may profit from this service. Because this study was n ot a truly randomized clinical trial, unintentional statistical bias m ay have occurred and caution is urged in interpreting the magnitude of apparent intergroup outcome differences.