Introduction: Recent governmental attempts to control health care costs have focused on reducing the incidence of complications, hospital-acquired conditions (HACs), and other provider preventable conditions (PPCs). One approach uses reduction or elimination of payments for complications, HACs, and PPCs; however, this method assumes all complications, HACs, and PPCs to be the same with payment restrictions applied uniformly. Patient-related factors, such as pre-existing comorbidities, likely influence perioperative complication incidence.
Methods: We conducted a retrospective assessment of prospectively collected morbidity and mortality events at a large pediatric neurosurgical unit over 5-years. We examined the impact of specific comorbidities and the cumulative effect of multiple comorbidities on complication incidence.
Results: 1990 patients underwent 3195 procedures at our tertiary care facility during the 5-year study period. 298 (15.0%) patients experienced at least one complication. At least one comorbidity was present in 45.9% of patients. Renal comorbidity was significantly associated with the development of a complication (p = 0.02), and it was specifically associated with wound-related complications (p = 0.006). Neurological comorbidities had a borderline association with complications (p = 0.05), and they were specifically associated with the complication of death (p = 0.037). An increased number of comorbidities, or patients with multiple comorbidities, did not correlate with an increased risk of complication.
There was also a general association between the type of surgery a patient underwent and the incidence of complications (p < 0.0001).
Conclusions: The incidence of perioperative complications in pediatric neurosurgery is dynamic and not subject to application of a uniform standard or definition. Complication incidence is variable and may be influenced by the type of neurosurgical procedure and patient-related factors, such as pre-existing comorbidities, such as renal or neurologic. Thus, while patient factors, beyond the control of the provider, can significantly impact complications and HACs in pediatric neurosurgery, an increasing number of comorbidities does not correlate with an increased risk of complications.
Patient Care: Help identify patients who are at increased risk for complication in pediatric neurosurgery, allowing for heightened vigilance. It will also shed light on how certain comorbidities can increase the risk of complications, in lieu of the new health care laws.
Learning Objectives: Study the relationship between patient-related factors, such as pre-existing comorbidities, and the incidence of perioperative complication in pediatric neurosurgery