Harbert Allie L, Barnett Randaline R, Abumoussa Andrew L, Goodnight William H, Tolleson-Rinehart Sue, Quinsey Carolyn S
1University of North Carolina School of Medicine, Chapel Hill, North Carolina.
2Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
J Neurosurg Pediatr. 2022 Mar 4;29(6):643-649. doi: 10.3171/2022.1.PEDS21425. Print 2022 Jun 1.
Relatively few women undergo open maternal-fetal surgery (OMFS) for myelomeningocele (MMC) despite the potential to reverse hindbrain herniation, reduce the rate of infant shunt-dependent hydrocephalus, and improve ambulation. These benefits have the potential to significantly reduce morbidity and lifetime medical care. In this study, the authors examined demographics and socioeconomic variables of women who were offered and opted for OMFS for MMC versus postnatal MMC surgery, with the purpose of identifying variables driving the disparity between these two patient populations.
This was a retrospective case-control study of patients who underwent evaluation for OMFS for MMC at a single academic hospital from 2015 to 2020. Race/ethnicity, primary insurance type, zip code, and BMI were collected and compared by treatment received and eligibility status for OMFS. Prevalence odds ratios were used to test for associations between each independent variable and the two outcomes. Logistical regression models were utilized to determine significant predictors of undergoing OMFS and being eligible for OMFS.
Of 96 women, 36 underwent OMFS for MMC, 40 received postnatal repair, and 20 either terminated the pregnancy or received care at another institution. Overall, 66 (68.8%) women were White, 14 (14.6%) were Black, 13 (13.5%) were Hispanic/Latinx, 1 (1.0%) was Asian, and 2 (2.1%) identified as other or multiple races. Among women who underwent OMFS for MMC, 27 (75.0%) were White, 2 (5.6%) were Black, 4 (11.1%) were Hispanic/Latinx, 1 (2.8%) was Asian, and 2 (5.6%) identified as other or multiple races. Having private insurance or TRICARE was associated with higher odds of being eligible for OMFS compared with women who were uninsured or had Medicaid when accounting for race and income (OR 3.87, 95% CI 1.51-9.59).
The population evaluated and treated for MMC was homogeneous and insufficiently representative of the population affected by the disease. This finding raises concern, as it suggests underlying barriers to formal evaluation for OMFS for MMC. Insurance status and BMI have a significant association between the access to and election of OMFS, revealing socioeconomic disparities. This was the first study to explore sociodemographic characteristics of patient populations who may be at risk for limited access to highly specialized fetal surgical care.
尽管开放性母胎手术（OMFS）有可能逆转后脑疝、降低婴儿依赖分流的脑积水发生率并改善行走能力，但接受该手术治疗脊髓脊膜膨出（MMC）的女性相对较少。这些益处有可能显著降低发病率和终身医疗护理需求。在本研究中，作者调查了接受并选择OMFS治疗MMC的女性与接受产后MMC手术的女性的人口统计学和社会经济变量，目的是确定导致这两组患者之间差异的变量。
这是一项回顾性病例对照研究，研究对象为2015年至2020年在一家学术医院接受MMC的OMFS评估的患者。收集种族/族裔、主要保险类型、邮政编码和体重指数，并根据接受的治疗和OMFS的资格状态进行比较。患病率比值比用于检验每个自变量与两个结果之间的关联。使用逻辑回归模型确定接受OMFS和符合OMFS资格的显著预测因素。
96名女性中，36名接受了MMC的OMFS，40名接受了产后修复，20名终止妊娠或在其他机构接受治疗。总体而言，66名（68.8%）女性为白人，14名（14.6%）为黑人，13名（13.5%）为西班牙裔/拉丁裔，1名（1.0%）为亚洲人，2名（2.1%）为其他或多种族。在接受MMC的OMFS的女性中，27名（75.0%）为白人，2名（5.6%）为黑人，4名（11.1%）为西班牙裔/拉丁裔，1名（2.8%）为亚洲人，2名（5.6%）为其他或多种族。在考虑种族和收入因素后，与未参保或有医疗补助的女性相比，拥有私人保险或军人医疗保险的女性符合OMFS资格的几率更高（比值比3.87，95%置信区间1.51 - 9.59）。
接受MMC评估和治疗的人群同质化程度高，对受该疾病影响的人群代表性不足。这一发现令人担忧，因为它表明MMC的OMFS正式评估存在潜在障碍。保险状况和体重指数与OMFS的可及性和选择之间存在显著关联，揭示了社会经济差异。这是第一项探索可能面临获得高度专业化胎儿手术护理机会有限风险的患者群体的社会人口学特征的研究。
