Introduction: Craniectomy for Chiari I malformations with or without dural decompression is a common neurosurgical procedure. There is considerable debate regarding indications and operative strategy for Chiari decompression. We aimed to address these controversies by analyzing national trends for complications, utility, and outcomes for Chiari I decompression.
Methods: The National Inpatient Sample was used to identify patients carrying a primary ICD-9 diagnosis code of Chiari I malformations between 1999-2009. The primary outcomes assessed were mortality, length of stay, total charges and complications. The secondary outcomes were dural repair status among surgically managed patients. The data was analyzed using univariate and multivariate regression (SAS).
Results: There were a total of 46,217 inpatient admissions for Chiari I malformations based upon NIS weighted estimates from 1999-2009.The overall surgical complication rate for Chiari I patients was 4.4%, of which pseudomeningocele and CSF leak rates comprised 2.2%. 18% of patients presented with syringomyelia upon admission. There was a higher likelihood of patients with syringomyelia to undergo surgical decompression versus their counterparts (19.3% vs. 14.3%, p<0.001). Additionally, Chiari I patients with syringomyelia were found to be more likely to undergo dural decompression as well (20.3% vs 16.6%, p<0.006). Patients undergoing dural repair as part of decompression had an increased overall length of stay compared to patients undergoing craniectomy alone (4.6 vs. 4.4 days, p<0.001). Additionally, total hospital charges for Chiari I patients undergoing dural decompression was also found to be significantly higher than those undergoing craniectomy alone ($37,122 vs. $35,444, p<0.003).
Conclusions: The total number of inpatient Chiari I cases and associated hospital charges have continued to increase over the past decade. Patients with syringomyelia seem to be more prone to undergoing operative management with dural decompression in addition to craniectomy. This data demonstrates that patients undergoing decompression have low complications rates with most undergoing routine discharges.
Patient Care: Helps Identify evolving trends in the management of Chiari I malformations nationally over the past decade, highlighting trends in demographics, complications, charges, outcomes while highlighting a number of contributing factors such as institutional type and operative vs. nonoperative management, provides large sample data to guide management of Chiari patients at a national level.
Learning Objectives: By the conclusion of this session, participants should be able to 1) identify national trends in Chiari I management; 2) appreciate differences in outcomes for patients undergoing surgical management of such pathology, with or without dural compression; 3) understand most common complications following Chiari I decompression based on upon national estimates; and 4) recognize increasing financial charges associated with the management of Chiari I .