Pediatric Moyamoya Outcomes Are Better in High Volume Centers

PE
Source: 
Stroke

Comprehensive data on the optimal treatment of and outcomes in pediatric moyamoya in the US is lacking.  Titsworth et al. assessed a total of 2454 moyamoya admissions from 1997 to 2012 in the Kids Inpatient Database.  The authors found that the care of moyamoya patients has been concentrating at high-volume centers during the past 12 years. Among moyamoya admission without surgical revascularization, high-volume hospitals show no difference in length of stay, cost, or complications compared with low-volume centers. However, low-volume hospitals have more nonroutine discharges and inpatient deaths when no revascularization was performed. In contrast, among admissions with surgical revascularization, high-volume centers had decreased length of stay, reduced cost, and no increase in complications compared with low-volume centers. Admissions with revascularization to low-volume hospitals also had increased likelihood of nonroutine discharge (compared with high-volume centers.  In the largest study of US pediatric moyamoya admissions to date, the authors found that  volume correlates with outcome, indicating high-volume centers provide significantly improved care and reduced mortality in pediatric moyamoya patients, with the most marked benefit observed in admissions for surgical revascularization.

Robert M. Starke, MD MSC
Charlottesville, VA