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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