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Kalluri AL, Jiang K, Abu-Bonsrah N, Ammar A, Reynolds R, Alomari S, Odonkor MN, Bhimreddy M, Ram N, Robinson S, Akbari SHA, Groves ML. Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles. Childs Nerv Syst 2024; 40:1177-1184. [PMID: 38133684 DOI: 10.1007/s00381-023-06254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To investigate differences in sociodemographic characteristics and short-term outcomes between patients undergoing prenatal versus postnatal myelomeningocele repair. METHODS Patients who underwent myelomeningocele repair at our institution were stratified based on prenatal or postnatal timing of repair. Baseline characteristics and outcomes were compared. Multivariate analysis was performed to identify whether prenatal repair was a predictor of outcomes independent of socioeconomic measures. RESULTS 49 patients underwent postnatal repair, and 30 underwent prenatal repair. Patients who underwent prenatal repair were more likely to have private insurance (73.3% vs. 42.9%, p = 0.03) and live farther from the hospital where they received their repair (251.5 ± 447.4 vs. 72.5 ± 205.6 miles, p = 0.02). Patients who underwent prenatal repair had shorter hospital stays (14.3 ± 22.7 days vs. 25.3 ± 20.1 days, p = 0.03), fewer complications (13.8% vs. 42.9%, p = 0.01), fewer 30-day ED visits (0.0% vs. 34.0%, p < 0.001), lower CSF diversion rates (13.8% vs. 38.8%, p = 0.02), and better functional status at 3-months (13.3% vs. 57.1% delayed, p = 0.009), 6-months (20.0% vs. 56.7% delayed, p = 0.03), and 1-year (29.4% vs. 70.6% delayed, p = 0.007). On multivariate analysis, prenatal repair was an independent predictor of inpatient complication (OR(95%CI): 0.19(0.05-0.75), p = 0.02) and 3-month (OR(95%CI): 0.14(0.03-0.80) p = 0.03), 6-month (OR(95%CI): 0.12(0.02-0.73), p = 0.02), and 1-year (OR(95%CI): 0.19(0.05-0.80), p = 0.02) functional status. CONCLUSION Prenatal repair for myelomeningocele is associated with better outcomes and developmental functional status. However, patients receiving prenatal closure are more likely to have private health insurance and live farther from the hospital, suggesting potential barriers to care.
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Affiliation(s)
- Anita L Kalluri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA.
| | - Adam Ammar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Rebecca Reynolds
- Department of Neurosurgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Michelle N Odonkor
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Meghana Bhimreddy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Natasha Ram
- Department of Neurosurgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Syed Hassan A Akbari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD, 21287, USA
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Best BJ, Cabacungan ET, Cohen SS, Kim I, Sherburne EC, Sawin KJ, Roach A, Foy AB. Trends in the early care of infants with myelomeningocele in the United States 2012-2018. Childs Nerv Syst 2023; 39:2413-2421. [PMID: 36308541 DOI: 10.1007/s00381-022-05704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The early care of children with spina bifida has changed with the increasing availability of fetal surgery and evidence that fetal repair improves the long-term outcomes of children with myelomeningocele. We sought to determine current trends in the prevalence and early care of children with myelomeningocele using a national administrative database. METHODS This is a retrospective, cross-sectional cohort study of infants with spina bifida admitted within the first 28 days of life using the 2012-2018 Healthcare Cost and Utilization Project National Inpatient Database. Patients with spina bifida were identified by ICD code and stratified into a cohort with a coded neonatal repair of the defect and those without a coded repair. This database had no identifier specific for fetal surgery, but it is likely that a substantial number of infants without a coded repair had fetal surgery. RESULTS We identified 5,090 patients with a coded repair and 5,715 without a coded repair. The overall prevalence of spina bifida was 3.94 per 10,000 live births. The percentage of patients without neonatal repair increased during the study period compared to those with repair (p = 0.0002). The cohort without neonatal repair had a higher risk of death (p < 0.001), prematurity (p < 0.001), and low birth weight (p < 0.001). More shunts were placed in patients who underwent neonatal repair (p < 0.001). Patients without neonatal repair were less likely to have public insurance (p = 0.0052) and more likely to reside in zip codes within the highest income quartile (p = 0.0002). CONCLUSIONS The prevalence of spina bifida from 2012 to 2018 was 3.94 per 10,000 live births, with an increasing number of patients without neonatal repair of the defect, suggesting increased utilization of fetal surgery. Patients without neonatal repair had a higher risk of death, prematurity, and low birth weight but were more likely to have commercial insurance and reside in high-income zip codes.
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Affiliation(s)
- Benjamin J Best
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Erwin T Cabacungan
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA
| | - Susan S Cohen
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Neonatology, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA
| | - Irene Kim
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
| | - Eileen C Sherburne
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Wisconsin, Milwaukee, WI, USA
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Audrey Roach
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
| | - Andrew B Foy
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Children's Wisconsin, Milwaukee, WI, USA
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