Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia

Rebecca A. Reynolds; Arnold Bhebhe; Roxanna M. Garcia; Heidi Chen; Christopher M. Bonfield; Sandi Lam; Kachinga Sichizya; Chevis Shannon

doi:10.1016/j.wneu.2020.10.069

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Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia

Journal article

Peer reviewed

Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia

Rebecca A. Reynolds, Arnold Bhebhe, Roxanna M. Garcia, Heidi Chen, Christopher M. Bonfield, Sandi Lam, Kachinga Sichizya and Chevis Shannon

World neurosurgery, Vol.145, pp.e332-e339

01/01/2021

DOI: 10.1016/j.wneu.2020.10.069

PMCID: 7755687

PMID: 33091647

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https://www.ncbi.nlm.nih.gov/pmc/articles/7755687View

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Abstract

Spina bifida disproportionally affects low-and-middle-income countries. We describe myelomeningocele surgical outcomes in Zambia and predictors of postoperative complications and mortality. This 2-center retrospective cohort study includes children who underwent surgical treatment for myelomeningocele in Lusaka, Zambia from 2017 to 2019. Primary outcomes included mortality and 30-day postoperative complications. Seventy-five patients were identified. Median age at first neurosurgical evaluation was 9 days (interquartile range [IQR], 6–21) and at surgery was 21 days (IQR 15–36). Lumbosacral myelomeningocele was most common (73%, n = 54). At first preoperative evaluation, 28% of the neural tube defects were deemed infected (n = 21), and 30% were leaking cerebrospinal fluid (n = 21). Postoperatively, 7% of patients died (n = 5), whereas 31% experienced a complication (n = 23). Most common complications included wound dehiscence (n = 10, 42%) and wound purulence (n = 6, 25%). Median follow-up duration was 41 days (IQR, 6–128). On univariable analysis, mortality was significantly associated with shorter follow-up duration (5 days [IQR, 2–7] vs. 46 days [IQR, 12–132]; P = 0.02) and any complication (P < 0.001). No variable was significantly associated with postoperative complication; however, 2 variables that notably neared significance were preoperative infection of the lesion (P = 0.05) and longer surgical delay (P = 0.06). Most patients born with myelomeningocele in Zambia present for first neurosurgical evaluation after 1 week of age. Preoperative infection of the lesion and postoperative complications are relatively common, and complications are a significant predictor of postoperative mortality. Further investigation into preoperative efforts to mitigate risk of postoperative complications and mortality is warranted.

Sub-Saharan Africa

Myelomeningocele

Neural tube defect

Spina bifida

Surgical outcomes

Details

Title: Subtitle: Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia
Creators: Rebecca A. Reynolds - Vanderbilt University Medical Center
Arnold Bhebhe - University Teaching Hospital
Roxanna M. Garcia - Northwestern University
Heidi Chen - Vanderbilt University Medical Center
Christopher M. Bonfield - Vanderbilt University Medical Center
Sandi Lam - Northwestern University
Kachinga Sichizya - University Teaching Hospital
Chevis Shannon - Vanderbilt University Medical Center
Resource Type: Journal article
Publication Details: World neurosurgery, Vol.145, pp.e332-e339
DOI: 10.1016/j.wneu.2020.10.069
PMID: 33091647
PMCID: 7755687
NLM abbreviation: World Neurosurg
ISSN: 1878-8750
eISSN: 1878-8769
Publisher: Elsevier Inc
Grant note: DOI: 10.13039/100000061, name: Fogarty International Center; DOI: 10.13039/100000002, name: National Institutes of Health
Language: English
Date published: 01/01/2021
Academic Unit: Neurosurgery
Record Identifier: 9984446520502771

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