1Department of Neurosurgery, University of North Carolina School of Medicine.
2Maternal Fetal Care Program, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill; and.
Neurosurg Focus. 2019 Oct 1;47(4):E14. doi: 10.3171/2019.7.FOCUS19355.
Hospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies.
The medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians.
A total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group.
Patients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.
医院再入院是一个重要的质量指标，但尚未在产前与产后脊髓脊膜膨出（MMC）修复中进行评估。本研究比较了这两组患者的再入院结局及其病因。
回顾性分析了 2011 年至 2017 年期间在一家学术医疗中心接受 MMC 修复的患者的病历。收集的临床数据包括手术和缺陷细节、新生儿重症监护病房（NICU）的住院时间，以及术后 1 年内的任何再入院或手术。采用双侧 t 检验和/或中位数相等的 k 样本检验分析患者和缺陷特征、NICU 出院后 30 天、60 天和 1 年的再入院结局，以及脑脊液（CSF）分流手术率。
在研究期间，共完成了 24 例产前和 34 例产后 MMC 修复。与产后修复组相比，产前修复患者出生更早（p<0.001），出生体重更低（p<0.001），但两组的 NICU 住院时间相似（p=0.59）。产前修复患者在 30 天（p=0.005）、90 天（p=0.004）和 1 年（p=0.007）的再入院率较低。脑积水是最常见的再入院病因，产前修复患者中有 29%在 1 年时需要 CSF 分流，而产后修复组有 81%（p<0.01）。需要 CSF 分流的产前修复患者在 CSF 分流手术时的体重（p=0.02）和年龄（p=0.01）均高于产后组。
与产后修复组相比，产前 MMC 修复患者在 30 天、60 天和 1 年的再入院率较低，尽管 NICU 住院时间相似。与产后修复组相比，产前修复组在 1 年时对 CSF 分流的需求较低，且在 CSF 分流手术时年龄较大，体重较重。应进一步研究再入院等医院质量指标，以更好地了解这两种手术的结局。
