Outcome data and analysis in pediatric neurosurgery

OBJECTIVE: The purpose of this study was to analyze the outcomes of five co mmonly performed pediatric neurosurgical operations: 1) initial shunt inser tion; 2) first shunt revision; 3) craniotomy for brain tumor; 4) correction of sagittal synostosis; and 5) release of tethered cords. A second purpose was to analyze the neurological outcome data after tethered cord releases. METHODS: Morbidity and mortality records, patient charts, and operative rec ords were reviewed to determine length of hospitalization and, for each dis order, the pertinent outcomes such as duration of shunt function and incide nce of infection or neurological morbidity. RESULTS: Many outcome data were expected, such as a high long-term shunt fu nction rate after primary shunt insertion (65% at 5 yr), a low mortality ra te (1%) and permanent morbidity rate (10%) after craniotomy for brain tumor , and a low frequency of transfusion (20%) fbr sagittal synostosis operatio ns. The outcomes among the three neurosurgeons varied more than expected, e .g., the duration of hospitalization after sagittal reconstructions ranged from 3.1 to 5.8 days; the frequency of infections of primary shunt revision s ranged from 0 to 15%; and the neurological morbidity after tethered cord releases ranged from 0 to 12%, with all neurological morbidity occurring in patients undergoing their second or third tether release. CONCLUSION: The data may serve as a basis for outcome comparisons for these procedures. Outcome data allow us to analyze factors to improve patient ca re, but outcome analysis is complex.