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Grand Rounds

What are the Common Surgical Procedures and Outcomes in Patients with Spina Bifida?

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BACKGROUND AND PURPOSE: 

  • Alabi et al. (Pediatrics, 2018) assessed the age distribution of common surgical procedures and health outcomes in patients with spina bifida (SB)

METHODS: 

  • Serial cross-sectional data of patients with spina bifida  
    • National Spina Bifida Patient Registry (2009–2013) 
  • Surgical procedures including  
    • GI | Neurologic | Orthopedic | Skin | Urologic | Other 
  • Health outcomes including  
    • Fecal continence | Urinary continence | Skin breakdown | Ambulation status 
  • Stratification 
    •  Age  
    • SB type: Myelomeningocele | Nonmyelomeningocele

RESULTS: 

  • 3801 patients had complete surgery data  
    • 83% of participants had myelomeningocele  
    • Approximately 50% were <10 years of age 
  • 91.4% of procedures occurred among participants with myelomeningocele  

Surgeries 

  • Distribution of procedures varied by age 
  • Most frequent procedure was neurologic 
    • 53% performed <1 year of age in both types of SB 
  • Most common: Spinal closure | Shunt insertion | Shunt revision 
  • Other procedures 
    • Orthopedic: 15.5% 
    • Urologic: 9.7% 
    • GI: 5.7% 
    • Skin: 5.2% 
    • Other: 4.9%  
  • Most other procedures performed at older ages (2 to 10 years) compared to neurologic surgeries 
  • In both types of SB, ≥88% of surgeries will have been performed by the time an individual reaches 18 year of age 

Health Outcomes 

  • Patients with myelomeningocele had lower frequencies of positive health outcomes vs those with nonmyelomeningocele regardless of age group 
  • Fecal incontinence (urinary incontinence showed similar results) 
    • ≤10 years of age had a lower rate of fecal continence than older patients 
  • Skin breakdown 
    • Prevalence of skin breakdown increased with age in those with myelomeningocele >12 years of age 
  • Ambulation 
    • 60% peak at 7 years of age then declined to 35% at ≥25 years of age 
    • Frequency of nonambulators is lowest at 5 years of age (18%) and highest at ≥25 years of age (54%) 
    • With the nonmyelomeningocele 80% to 90% retained community ambulation status, regardless of age  
  • Overall, the rates of fecal and urinary continence and skin breakdown increased with age whereas the ability to ambulate declined with age

CONCLUSION: 

  • Neurological surgery was 3X more frequent than other surgeries combined  
  • Myelomeningocele results in a much lower frequency of positive health outcomes, compared to patients with nonmyelomeningocele SB

Learn More – Primary Sources: 

Surgeries and Health Outcomes Among Patients With Spina Bifida

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