Introduction: Moya Moya is a rare disease, and thus there have been few published studies with sufficient power for outcomes analyses of bypass surgery performed in the modern era.

Methods: This Kids Inpatient Database (KID) was queried for hospitalizations of pediatric patients with moya moya disease undergoing extracranial-intracranial vascular bypass surgery in the years 2003, 2006, and 2009. Type of bypass (direct vs indirect) was not distinguishable in coding. Multivariate logistic regression was conducted to identify covariates associated with in-hospital complications.

Results: An estimated total of 477 hospitalizations for bypass surgery were identified in the years of the study. The mean age was 9.5 years. The incidence of Down's Syndrome in the cohort was 7%, of Sickle Cell hemoglobinopathy was 12.1%, of neurofibromatosis type 1 was 5.9%, and of pre-existing neurological deficit was 21%. The incidence of in-hospital complications were as follows: postoperative stroke 1%, subdural hematoma 0.4%, death 0.4%, seizures 12.2%, wound infection 1%, meningitis 0.4%, sepsis 0.4%, CSF leak 0.7%. There were no cases of cardiopulmonary collapse or DVT/PE. In a multivariate regression model controlling for demographics, hospital and clinical factors; longer length of stay (OR 1.12, p=0.027), increased number of procedures done during hospitalization (OR 2.2, p=0.04), and presence of one of four comorbidities (Down's syndrome, NF1, Sickle Cell, pre-existing neurologic deficit) (OR 2.3, p=0.034) were significantly associated with increased risk of complications. Age, sex, race, hospital type or location, and hospital volume were not significantly associated with outcomes.

Conclusions: Increased length of stay, increased number of procedures done in-hospital, and the presence of certain comorbidities were associated with a higher incidence of complications among pediatric patients undergoing bypass surgery for Moya Moya disease.

Patient Care: By providing groundwork for future prospective studies on complication reduction among pediatric patients with Moya Moya disease undergoing bypass surgery.

Learning Objectives: By the conclusion of this session, participants should be able to 1. Identify the incidence of complications among pediatric patients undergoing bypass surgery for Moya Moya disease 2. Identify the risk factors that contribute to those complications.

References: Howard BM, Barrow DL. Cerebral Revascularization: Which Patients Should Be Bypassed and Which Patients Should Be Passed by? World Neurosurg. 2015 Jan 14. Pandey P, Steinberg GK. Neurosurgical advances in the treatment of moyamoya disease. Stroke. 2011 Nov;42(11):3304-10. Jin SC, Oh CW, Kwon OK, Hwang G, Bang JS, Kang HS, Kim JE, Lee SH, Chung YS. Epilepsy after bypass surgery in adult moyamoya disease. Neurosurgery. 2011 May;68(5):1227-32;