Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles

Anita L. Kalluri; Kelly Jiang; Nancy Abu-Bonsrah; Adam Ammar; Rebecca Reynolds; Safwan Alomari; Michelle N. Odonkor; Meghana Bhimreddy; Natasha Ram; Shenandoah Robinson; Syed Hassan A. Akbari; Mari L. Groves

doi:10.1007/s00381-023-06254-y

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Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles

Journal article

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Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles

Anita L. Kalluri, Kelly Jiang, Nancy Abu-Bonsrah, Adam Ammar, Rebecca Reynolds, Safwan Alomari, Michelle N. Odonkor, Meghana Bhimreddy, Natasha Ram, Shenandoah Robinson, …

Child's nervous system, Vol.40(4), pp.1177-1184

04/01/2024

DOI: 10.1007/s00381-023-06254-y

PMID: 38133684

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Abstract

Purpose To investigate differences in sociodemographic characteristics and short-term outcomes between patients undergoing prenatal versus postnatal myelomeningocele repair. Methods Patients who underwent myelomeningocele repair at our institution were stratified based on prenatal or postnatal timing of repair. Baseline characteristics and outcomes were compared. Multivariate analysis was performed to identify whether prenatal repair was a predictor of outcomes independent of socioeconomic measures. Results 49 patients underwent postnatal repair, and 30 underwent prenatal repair. Patients who underwent prenatal repair were more likely to have private insurance (73.3% vs. 42.9%, p=0.03) and live farther from the hospital where they received their repair (251.5447.4 vs. 72.5 +/- 205.6 miles, p=0.02). Patients who underwent prenatal repair had shorter hospital stays (14.3 +/- 22.7 days vs. 25.3 +/- 20.1 days, p=0.03), fewer complications (13.8% vs. 42.9%, p=0.01), fewer 30-day ED visits (0.0% vs. 34.0%, p<0.001), lower CSF diversion rates (13.8% vs. 38.8%, p=0.02), and better functional status at 3-months (13.3% vs. 57.1% delayed, p=0.009), 6-months (20.0% vs. 56.7% delayed, p=0.03), and 1-year (29.4% vs. 70.6% delayed, p=0.007). On multivariate analysis, prenatal repair was an independent predictor of inpatient complication (OR(95%CI): 0.19(0.05-0.75), p=0.02) and 3-month (OR(95%CI): 0.14(0.03-0.80) p=0.03), 6-month (OR(95%CI): 0.12(0.02-0.73), p=0.02), and 1-year (OR(95%CI): 0.19(0.05-0.80), p=0.02) functional status. Conclusion Prenatal repair for myelomeningocele is associated with better outcomes and developmental functional status. However, patients receiving prenatal closure are more likely to have private health insurance and live farther from the hospital, suggesting potential barriers to care.

Pediatrics

Surgery

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Science & Technology

Details

Title: Subtitle: Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles
Creators: Anita L. Kalluri - Johns Hopkins University
Kelly Jiang - Johns Hopkins University
Nancy Abu-Bonsrah - Johns Hopkins University
Adam Ammar - Johns Hopkins University
Rebecca Reynolds - Johns Hopkins University
Safwan Alomari - Johns Hopkins University
Michelle N. Odonkor - Johns Hopkins University
Meghana Bhimreddy - Johns Hopkins University
Natasha Ram - Johns Hopkins All Childrens Hosp, Dept Neurosurg, St Petersburg, FL USA
Shenandoah Robinson - Johns Hopkins University
Syed Hassan A. Akbari - Johns Hopkins University
Mari L. Groves - Johns Hopkins Medicine
Resource Type: Journal article
Publication Details: Child's nervous system, Vol.40(4), pp.1177-1184
DOI: 10.1007/s00381-023-06254-y
PMID: 38133684
ISSN: 0256-7040
eISSN: 1433-0350
Publisher: Springer Nature
Number of pages: 8
Language: English
Date published: 04/01/2024
Academic Unit: Neurosurgery
Record Identifier: 9985179098602771

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