University of Virginia, Charlottesville, VA 22908-0710, USA.
Pain Physician. 2012 Jan-Feb;15(1):65-74.
Intrathecal delivery of baclofen (ITB) is effective at controlling spasticity. However, it requires the placement of a catheter into the intrathecal space, and a pump with a reservoir for the medication. The process of placing the catheter and pump are prone to complications.
The objective of this paper is to determine factors contributing to rising complication rates after intrathecal catheter/pump placement in a national sample of pediatric patients.
This was a retrospective observational database study.
We queried the Kids' Inpatient Database for all children greater than 4 years old and under 20 years old for the years 1997, 2000, 2003, and 2006 who had an intrathecal catheter and pump placed. We then compared demographics and hospital characteristics of patients with and without complications. We performed univariate and multivariate analyses to determine the relative contribution of various factors to the development of complications.
We identified 2,843 patients who met our criteria, and 514 of these patients had one or more complications after placement of intrathecal pump/catheter. There were 1.14 complications per patient. The complication rate was 10.2% in 1997, and increased to 21.9% in 2006. Mechanical complications were the most common type of complication in this population, account for nearly two-thirds of all complications occurring. Age, hospital type, hospital size, and admission source were independent predictors of complications.
We did not have access to ASA status, operative details, and access to patient charts.
Complication rates after placement of intrathecal pump/catheters have increased in the pediatric population between 1997 and 2006 mainly due to an increase in mechanical complications.
鞘内给予巴氯芬（ITB）可有效控制痉挛。然而，这需要将导管放置到鞘内空间，并使用带有药物储液器的泵。导管和泵的放置过程容易发生并发症。
本研究旨在确定全国儿科患者鞘内导管/泵植入后并发症发生率上升的相关因素。
这是一项回顾性观察性数据库研究。
我们在 1997 年、2000 年、2003 年和 2006 年，检索 Kids' Inpatient Database 中所有 4 岁以上、20 岁以下的鞘内导管和泵植入患者，比较有和无并发症患者的人口统计学和医院特征。我们进行单变量和多变量分析，以确定各种因素对并发症发生的相对贡献。
我们确定了 2843 名符合条件的患者，其中 514 名患者在鞘内泵/导管放置后出现 1 种或多种并发症。每位患者有 1.14 种并发症。1997 年的并发症发生率为 10.2%，2006 年增加至 21.9%。机械并发症是该人群中最常见的并发症类型，占所有并发症的近三分之二。年龄、医院类型、医院规模和入院来源是并发症的独立预测因素。
我们无法获得 ASA 状态、手术细节和患者病历。
1997 年至 2006 年间，鞘内泵/导管放置后并发症发生率在儿科人群中增加，主要原因是机械并发症增加。
