TY - JOUR
T1 - Trends in the presentation, surgical treatment, and outcomes of tethered cord syndrome
T2 - A nationwide study from 2001 to 2010
AU - Jalai, Cyrus M.
AU - Wang, Charles
AU - Marascalchi, Bryan J.
AU - Horn, Samantha R.
AU - Poorman, Gregory W.
AU - Bono, Olivia J.
AU - Frempong-Boadu, Anthony K.
AU - Passias, Peter G.
N1 - Publisher Copyright:
© 2017 Elsevier Ltd
PY - 2017/7
Y1 - 2017/7
N2 - Objective This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications. Materials and methods Retrospective review of the Nationwide Inpatient Sample 2001–2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9 years] vs. adolescent [10–18 year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality. Results 6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p < 0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p < 0.001), cardiac (OR 0.27, p < 0.001), respiratory (OR 0.26, p < 0.001), digestive system (OR 0.32, p < 0.001), puncture nerve/vessel (OR 0.56, p = 0.009), wound (OR 0.25, p < 0.001), infection (OR 0.29, p < 0.001), posthemorrhagic anemia (OR 0.04, p = 0.002), ARDS (OR 0.13, p < 0.001), and venous thrombotic (OR 0.53, p = 0.043) complications. Detethering increased nervous system (OR 1.34, p = 0.049) and urinary (OR 2.60, p < 0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p < 0.001), LOS (5.77 vs. 4.13 days, p < 0.001), and charges ($54,592.28 vs. $33,043.83, p < 0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p < 0.001) than pediatric. Conclusions With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.
AB - Objective This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications. Materials and methods Retrospective review of the Nationwide Inpatient Sample 2001–2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9 years] vs. adolescent [10–18 year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality. Results 6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p < 0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p < 0.001), cardiac (OR 0.27, p < 0.001), respiratory (OR 0.26, p < 0.001), digestive system (OR 0.32, p < 0.001), puncture nerve/vessel (OR 0.56, p = 0.009), wound (OR 0.25, p < 0.001), infection (OR 0.29, p < 0.001), posthemorrhagic anemia (OR 0.04, p = 0.002), ARDS (OR 0.13, p < 0.001), and venous thrombotic (OR 0.53, p = 0.043) complications. Detethering increased nervous system (OR 1.34, p = 0.049) and urinary (OR 2.60, p < 0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p < 0.001), LOS (5.77 vs. 4.13 days, p < 0.001), and charges ($54,592.28 vs. $33,043.83, p < 0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p < 0.001) than pediatric. Conclusions With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.
KW - Detethering vs. fusion
KW - In-hospital complications
KW - Surgical management
KW - Tethered cord syndrome
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U2 - 10.1016/j.jocn.2017.03.034
DO - 10.1016/j.jocn.2017.03.034
M3 - Article
C2 - 28342704
AN - SCOPUS:85016080740
SN - 0967-5868
VL - 41
SP - 92
EP - 97
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -