Introduction: Chiari I malformations are common in adults, and a frequent procedure in neurosurgical practice. Despite a number of studies, to date there is no consensus about the indications or surgical technique for this common condition. Growing emphasis on value-based care has emphasized reduction of readmissions and reoperations, and is particularly relevant in Chiari, which has traditionally been associated with a high complication rate. In this study we provide the first large, multi-center study providing a contemporary profile of risk factors and complications for this frequent operation.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to determine 30-day outcomes following surgery for Chiari I malformations in adults between 2005 and 2016. Demographics, clinical risk factors, and postoperative events were analyzed, along with reoperation and readmission reasons.
Results: 672 adult patients were identified in the cohort, with a female predominance (80%). The overall cohort readmission rate was 9.3%, and 6.8% of patients returned to the operating room. Obesity (45.7%) was predictive of both readmission and reoperation risk. Male sex and American Society of Anesthesiology (ASA) class were predictive for reoperations. The most common reason for reoperation was CSF leak, which was responsible for nearly two-thirds of reoperations and 4% of the cohort.
Conclusions: Surgery for Chiari in adults is common, and carries a definitive risk profile including rates of readmission and reoperation higher than other common neurosurgical procedures. This cohort provides a representative sample of contemporary neurosurgical outcomes in surgery for Chiari I malformations.
Patient Care: Chiari malformations are common in neurosurgery. Although several studies comparing outcomes after Chiari surgery have been performed, almost all have been confined to single center or single surgeon studies. This study has the potential to improve patient care by providing a large, representative, international sample of outcomes following surgery for Chiari I malformations. These results will aid in decision making by helping the surgeon identify patients at elevated risk for poorer outcomes, and to counsel them appropriately prior to procedures.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify risk factors associated with readmission and reoperation after surgery for Chiari I malformations.
2) Characterize the readmission and reoperation rate for Chiari malformation surgery.
3) Describe the most common reasons for readmission or reoperation after Chiari decompression, their frequency, and council patients in preparation for surgery.