Purpose

For young children and adolescents with Chiari malformation type I (CM-I), the determinants of extended length of hospital stay (LOS) after neurosurgical suboccipital decompression are obscure. Here, we investigate the impact of patient- and hospital-level risk factors on extended LOS following surgical decompression for CM-I in young children to adolescents.

Methods

The Kids’ Inpatient Database year 2012 was queried. Pediatric CM-I patients (6–18 years) undergoing surgical decompression were identified. Weighted patient demographics, comorbidities, complications, LOS, disposition, and total cost were recorded. A multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. The primary outcome was the degree patient comorbidities or post-operative complications correlated with extended LOS.

Results

A total of 1592 pediatric CM-I patients were identified for which 328 (20.6%) patients had extended LOS (normal LOS, 1264; extended LOS, 328). Age, gender, race, median household income quartile, and healthcare coverage distributions were similar between the two cohorts. Patients with extended LOS had significantly greater admission comorbidities including headache symptoms, nausea and vomiting, obstructive hydrocephalus, lack of coordination, deficiency anemias, and fluid and electrolyte disorders. On multivariate logistic regression, several risk factors were associated with extended LOS, including headache symptoms, obstructive hydrocephalus, and fluid and electrolyte disorders.

Conclusions

Our study using the Kids’ Inpatient Database demonstrates that presenting symptoms and signs, including headaches and obstructive hydrocephalus, respectively, are significantly associated with extended LOS following decompression for pediatric CM-I.

中文翻译：

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术前头痛和阻塞性脑积水预测小儿Chiari I畸形在枕下减压后的住院时间延长。

目的

对于I型Chiari畸形（CM-I）的年幼儿童和青少年，枕下神经外科手术后延长住院时间（LOS）的决定因素不清楚。在这里，我们调查了针对儿童和青少年的CM-1减压手术后患者和医院级别的危险因素对LOS延长的影响。

方法

查询了2012年儿童住院数据库。确定了接受手术减压的小儿CM-1患者（6-18岁）。记录患者的加权人口统计资料，合并症，并发症，LOS，处置和总费用。多元logistic回归用于确定风险调整后LOS的优势比。主要结果是患者合并症或术后并发症与长期LOS相关的程度。

结果

总共确定了1592名小儿CM-I患者，其中328例（20.6％）患有长期LOS（正常LOS，1264；扩展LOS，328）。两个队列之间的年龄，性别，种族，家庭收入中位数四分位数和医疗保健覆盖范围分布相似。LOS延长患者的入院合并症显着增加，包括头痛症状，恶心和呕吐，梗阻性脑积水，缺乏协调性，贫血性贫血以及体液和电解质紊乱。在多因素logistic回归分析中，一些危险因素与LOS延长有关，包括头痛症状，阻塞性脑积水以及体液和电解质紊乱。

结论

我们使用儿童住院数据库进行的研究表明，分别出现症状和体征（包括头痛和阻塞性脑积水）与小儿CM-1减压后长期LOS显着相关。