Introduction: Chiari I decompression (C1D) is a common pediatric neurosurgical procedure. Inpatient C1D postoperative care is often notable for pain and poor activity. Initiation of rehabilitation therapies, including physical, occupational, massage, and recreational, may impact recovery, but published evidence is scant.
Methods: An electronic medical record query by CPT code identified all patients who underwent C1D at our pediatric tertiary-care hospital from January 1, 2012 through February 20, 2016. Chiari II, redo C1D, and unrelated foramen magnum decompression operations were excluded. Demographic, financial, surgical, therapy, and outcome data were analyzed.
Results: The study population included 59 patients with a mean age of 11-years-old (range 1-18) and gender distribution of 56% male. Sixty-one percent (36/59) had private insurance and 39% (23/59) had public insurance. C1D was intradural in 75% (44/59) and extradural in 25% (15/59). Seventy-three percent of patients (43/59) received at least one form of rehabilitation therapy. Table 1 details inpatient length of stay (LOS), reoperation rate for surgical complication, and readmission rate within 30 days for each group. Public insurance was associated with a higher reoperation and readmission rate than private insurance. Intradural surgery was associated with a greater LOS, reoperation rate, and readmission rate than extradural surgery. Having received any rehabilitation therapy was associated with an increased LOS compared with no therapy, even when stratified for intradural versus extradural surgery, but a lower readmission rate. An association of therapy with reoperation rate was less distinct.
Conclusions: In our population, rehabilitation therapy was associated with an increased inpatient LOS but a lower readmission rate. It is possible that the initiation of therapy was a marker for a more symptomatic child who would require more time to recover. It is also possible that the lower readmission rate related to an increased discharge readiness among the therapy group. Further investigation is ongoing.
Patient Care: This research may aid in the continued quest for optimal care of the patient with a Chiari 1 malformation.
Learning Objectives: By the conclusion of this session, participants should be able to assess the outcomes of Chiari 1 decompression surgery in our population by: 1) type of insurance, 2) status of the dura, and 3) initiation of rehabilitation therapies.