Child's Nervous System

, Volume 35, Issue 4, pp 657–664 | Cite as

Outcomes and resource utilization in surgery for Chiari I malformation in a national network of children’s hospitals

  • Melissa A. LoPrestiEmail author
  • I-Wen Pan
  • Nisha Gadgil
  • Kathryn Wagner
  • Sandi Lam
Original Paper



Chiari malformation type 1 (CM-1) is a common congenital or acquired malformation of the posterior fossa. We aimed to characterize preoperative risk factors, perioperative complications, and postoperative outcomes related to CM-1 surgery in pediatric populations across a nationwide network of pediatric hospitals in the United States (US).


The Children’s Hospital Association’s Pediatric Health Information System (PHIS) database was used to examine patients < 21 years old in the US-based nationwide database who underwent inpatient surgery for CM-1 from 2007 to 2015. Data analyzed included patient characteristics, preoperative comorbidities, perioperative outcomes, short-term postoperative surgical and medical complications, and healthcare resource utilization.


Among the 5976 patients identified, those age 0–4 years had higher medical and surgical complication rates compared to older patients. Those with pre-existing comorbidity of hydrocephalus had higher odds of 30- and 90-day medical and surgical complications. Those with any complications at 90 days had an increased length of stay and higher healthcare costs compared to those without complications. 6.88% of complications were surgical and 1.67% medical. Patients with medical complications had the longer mean stay and associated costs compared to those with surgical complications (13 vs. 6.9 at 95% CI, and $71,300–94,500 vs. $110,400–195,000 at 95% CI).


Use of a US-based national children’s hospital database presents outcomes and resource utilization from a multi-institutional, real-world experience in pediatric hospitals. There was a higher risk of perioperative complications in younger patients and those with pre-existing comorbidities, namely hydrocephalus. Understanding preoperative risk factors, perioperative complications, and postoperative outcomes, as well as healthcare utilization and costs, can help target areas for improvement and guide preoperative counseling and risk stratification.


Chiari malformation Outcomes Pediatric National database 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Cost-to-charge ratio files. Healthcare Cost and Utilization Project (HCUP). Accessed at: Accessed on: Nov 6, 2018
  2. 2.
    Dure LS, Percy AK, Cheek WR, Laurent JP (1989) Chiari type 1 malformation in children. J Pediatr 115(4):573–576CrossRefGoogle Scholar
  3. 3.
    Fukuoka T, Nishimura Y, Hara M, Haimoto S, Eguchi K, Yoshikawa S, Wakabayaski T, Ginsberg HJ (2017) Chiari type 1 malformation-induced intracranial hypertension with diffuse brain edema treated with foramen magnum decompression: a case report. NMC Case Rep J 4(4):115–120CrossRefGoogle Scholar
  4. 4.
    Greenberg JK, Ladner TR, Olsen MA, Shannon CN, Liu J, Yarbrough CK, Piccirillo JF, Wellons JC 3rd, Smyth MD, Park TS, Limbrick DD (2015) Complications and resource use associated with surgery for Chiari malformation type 1 in adults: a population perspective. Neurosurgery 77:261–268CrossRefGoogle Scholar
  5. 5.
    Greenberg JK, Lander TR, Olsen MA, Shannon CN, Liu J, Yarbrough CK, Piccirillo JF, Wellons JC 3rd, Smyth MD, Park TS, Limbrick DD (2015) Validation of an ICD-9 code algorithm for identifying Chiari malformation type 1 surgery in adults. Neurosurgery 77:269–273CrossRefGoogle Scholar
  6. 6.
    Greenberg JK, Olsen MA, Yarbrough CK, Ladner TR, Shannon CN, Piccirillo JF, Anderson RC, Wellons JC 3rd, Smyth MD, Park TS, Limbrick DD Jr (2016) Chiari malformation type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York. J Neurosurg Pediatr 17:525–532CrossRefGoogle Scholar
  7. 7.
    Hankinson TC, Tuite GF, Moscoso DI, Robinson LC, Torner JC, Limbrick DD Jr, Park TS, Anderson RCE (2017) Analysis and interrater reliability of pB-C2 using MRI and CT: data from the Park-Reeves Syringomyelia Research Consortium on behalf of the Pediatric Craniocervical Society. J Neurosurg Pediatr 20(2):170–175CrossRefGoogle Scholar
  8. 8.
    Ladner TR, Greenberg JK, Guerrero N, Olsen MA, Shannon CN, Yarbrough CK, Piccirillo JF, Anderson RC, Feldstein NA, Wellons JC 3rd, Smyth MD, Park TS, Limbrick DD Jr (2016) Chiari malformation type I surgery in pediatric patients. Part 1: validation of an ICD-9-CM code search algorithm. J Neurosurg Pediatr 17:519–524CrossRefGoogle Scholar
  9. 9.
    Lam SK, Mayer RR, Luerssen TG, Pan IW (2016) Hospitalization cost model of pediatric surgical treatment of Chiari type 1 malformation. J Pediatr 179:204–210CrossRefGoogle Scholar
  10. 10.
    Passias PG, Pyne A, Horn SR, Poorman GW, Janjua MB, Vasquez-Montes D, Bortz CA, Segreto FA, Frangella NJ, Siow MY, Sure A, Zhou PL, Moon JY, Diebo BG, Vira SN (2018) Developments in the treatment of Chiari type 1 malformations over the past decade. J Spine Surg 4(1):45–54CrossRefGoogle Scholar
  11. 11.
    Patient-Centered Outcomes Research Institute (USA) (2015) Posterior fossa decompression with or without duraplasty for Chiari type 1 malformation with syringomyelia. Patient-Centered Outcomes Research Institute, Washington, DC ( [Accessed July 5, 2018]Google Scholar
  12. 12.
    PHIS. Pediatric Health Information System. Children’s Hospital Association. Accessed at: Accessed on: 11/6/2018
  13. 13.
    Ramon C, Gonzales-Madly A, Pascual J (2011) What differences exist in the appropriate treatment of congenital versus acquired adult Chiari type 1 malformation? Curr Pain Headache Rep 15(3):157–163CrossRefGoogle Scholar
  14. 14.
    Tubbs RS, McGirt MJ, Oakes WJ (2003) Surgical experience in 130 pediatric patients with Chiari I malformations. J Neurosurg 99(2):291–296CrossRefGoogle Scholar
  15. 15.
    Vendantam A, Mayer RR, Staggers KA, Harris DA, Pan IW, Lam SK (2016) Thirty-day outcomes for posterior fossa decompression in children with Chiari type 1 malformation from the US NSQIP-Pediatric database. Childs Nerv Syst 32(11):2165–2171CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Baylor College of Medicine, Division of Pediatric NeurosurgeryTexas Children’s HospitalHoustonUSA
  2. 2.Department of NeurosurgeryBaylor College of MedicineHoustonUSA

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