scholarly journals Rising Complication Rates after Intrathecal Catheter and Pump Placement in the Pediatric Population: Analysis of National Data Between 1997 and 2006

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. 65-74
Author(s):  
Dr. Zhiyi Zuo
Keyword(s):  
Population Analysis ◽  
Pediatric Population ◽  
National Sample ◽  
Intrathecal Baclofen ◽  
Complication Rates ◽  
Intrathecal Catheter ◽  
Hospital Size ◽  
Mechanical Complications ◽  
Relative Contribution ◽  
Pump Placement

Background: Intrathecal delivery of baclofen (ITB) is effective at controlling spasticity. However, it requires the placement of a catheter into the intrathecal space, and a pump with a reservoir for the medication. The process of placing the catheter and pump are prone to complications. Objectives: The objective of this paper is to determine factors contributing to rising complication rates after intrathecal catheter/pump placement in a national sample of pediatric patients. Study Design: This was a retrospective observational database study. Methods: We queried the Kids’ Inpatient Database for all children greater than 4 years old and under 20 years old for the years 1997, 2000, 2003, and 2006 who had an intrathecal catheter and pump placed. We then compared demographics and hospital characteristics of patients with and without complications. We performed univariate and multivariate analyses to determine the relative contribution of various factors to the development of complications. Results: We identified 2,843 patients who met our criteria, and 514 of these patients had one or more complications after placement of intrathecal pump/catheter. There were 1.14 complications per patient. The complication rate was 10.2% in 1997, and increased to 21.9% in 2006. Mechanical complications were the most common type of complication in this population, account for nearly two-thirds of all complications occurring. Age, hospital type, hospital size, and admission source were independent predictors of complications. Limitations: We did not have access to ASA status, operative details, and access to patient charts. Conclusions: Complication rates after placement of intrathecal pump/catheters have increased in the pediatric population between 1997 and 2006 mainly due to an increase in mechanical complications. Key words: Intrathecal, baclofen, catheter, pediatric, kids, complications, spasticity

A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative

2018 ◽  
Vol 21 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Virendra R. Desai ◽  
Jeffrey S. Raskin ◽  
Arvind Mohan ◽  
JoWinsyl Montojo ◽  
Valentina Briceño ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Relative Risk ◽  
Infection Prevention ◽  
Pediatric Population ◽  
Compliance Rate ◽  
Intrathecal Baclofen ◽  
Quality Improvement Initiative ◽  
Complication Rates ◽  
Improvement Project ◽  
The Absolute

OBJECTIVEIntrathecal baclofen pumps are generally placed in children for the treatment of spasticity and dystonia. Use of implants in this pediatric population with comorbidities is reported to have a high risk of complications and infections. With the aim of reducing baclofen pump–related infections, a quality improvement project was instituted at the authors’ institution.METHODSA workflow paradigm unique to baclofen pump implantation aimed at decreasing implant-related infections was implemented. All baclofen pump operations performed at the authors’ institution between August 2012 and June 2016 were reviewed. An infection prevention protocol was created and implemented in August 2014 based on a literature review and the consensus opinion of the pediatric neurosurgeons in the group. Compliance with the prevention bundle was tracked. Case outcomes before and after implementation of the protocol with a minimum of 3 months of follow-up were retrospectively reviewed. Univariate and multivariate analyses were performed to assess the association of the steps in the prevention bundle with infection and complication outcomes.RESULTSA total of 128 baclofen pump surgeries were performed (64 preprotocol and 64 postprotocol). The patient age range was 3 to 27 years. The overall compliance rate with the infection prevention bundle was 82%. The pre- and postimplementation infection rates were 12.5% and 6.3%, respectively (p = 0.225). The total pre- and postimplementation complication rates were 23.4% and 9.4%, respectively (p = 0.032). The absolute and relative risk reductions for infections were 6.3% (95% CI 3.8%–16.3%) and 50%, respectively; for complications, the absolute and relative risk reductions were 14.1% (95% CI 1.5%–26.7%) and 60%, respectively.CONCLUSIONSThe total complication rate following intrathecal baclofen pump surgery was significantly lower after implementation of the quality improvement protocol. This study is an example of using checklist standardization to diminish special cause variability.

Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program

2016 ◽  
Vol 32 (6) ◽  
pp. 611-616 ◽  
Author(s):  
Lane Koenig ◽  
Samuel A. Soltoff ◽  
Berna Demiralp ◽  
Akinluwa A. Demehin ◽  
Nancy E. Foster ◽  
...  
Keyword(s):  
Complication Rates ◽  
Safety Measures ◽  
Hospital Size ◽  
Simulated Likelihood ◽  
C Statistic ◽  
Bottom Quartile ◽  
Reduction Program ◽  
Empirical Performance ◽  
Hospital Acquired

In 2016, Medicare’s Hospital-Acquired Condition Reduction Program (HAC-RP) will reduce hospital payments by $364 million. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the assignment of penalties. This study investigated possible bias in the HAC-RP by simulating hospitals’ likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure’s complication rate. For 3 of 8 measures examined, the equal-quality simulation identified poor performers similarly to empirical data (c-statistic approximately 0.7 or higher) and explained most of the variation in empirical performance by size (Efron’s R2 > 0.85). The Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader “all-harm” measure.

scholarly journals Laser interstitial thermal therapy for subependymal giant cell astrocytoma: technical case report

2016 ◽  
Vol 41 (4) ◽  
pp. E9 ◽  
Author(s):  
David Y. A. Dadey ◽  
Ashwin A. Kamath ◽  
Eric C. Leuthardt ◽  
Matthew D. Smyth
Keyword(s):  
Giant Cell ◽  
Pediatric Population ◽  
Thermal Therapy ◽  
Subependymal Giant Cell Astrocytoma ◽  
Complication Rates ◽  
Open Resection ◽  
Laser Interstitial Thermal Therapy ◽  
Intracranial Lesions ◽  
Giant Cell Astrocytoma

Subependymal giant cell astrocytoma (SEGA) is a rare tumor occurring almost exclusively in patients with tuberous sclerosis complex. Although open resection remains the standard therapy, complication rates remain high. To minimize morbidity, less invasive approaches, such as endoscope-assisted resection, radiosurgery, and chemotherapy with mTOR pathway inhibitors, are also used to treat these lesions. Laser interstitial thermal therapy (LITT) is a relatively new modality that is increasingly used to treat a variety of intracranial lesions. In this report, the authors describe two pediatric cases of SEGA that were treated with LITT. In both patients the lesion responded well to this treatment modality, with tumor shrinkage observed on follow-up MRI. These cases highlight the potential of LITT to serve as a viable minimally invasive therapeutic approach to the management of SEGAs in the pediatric population.

Intrathecal baclofen therapy for spasticity of cerebral origin—does the position of the intrathecal catheter matter?

2010 ◽  
Vol 26 (8) ◽  
pp. 1097-1102 ◽  
Author(s):  
Gnanamurthy Sivakumar ◽  
Yoong Yap ◽  
Mekidm Tsegaye ◽  
Michael Vloeberghs
Keyword(s):  
Intrathecal Baclofen ◽  
Intrathecal Catheter ◽  
Intrathecal Baclofen Therapy

Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

2018 ◽  
Vol 35 (9) ◽  
pp. 869-874 ◽  
Author(s):  
Jacob Bell ◽  
Munish Goyal ◽  
Sallie Long ◽  
Anagha Kumar ◽  
Joseph Friedrich ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Complication Rate ◽  
Venous Catheter ◽  
Complication Rates ◽  
Central Venous ◽  
Site Specific ◽  
Mechanical Complications ◽  
Significant Difference ◽  
Insertion Techniques ◽  
Delayed Complications

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. Results: In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. Conclusions: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy

1998 ◽  
Vol 88 (1) ◽  
pp. 73-76 ◽  
Author(s):  
A. Leland Albright ◽  
Margaret J. Barry ◽  
Michael J. Painter ◽  
Barbara Shultz
Keyword(s):  
Cerebral Palsy ◽  
Intrathecal Baclofen ◽  
Term Therapy ◽  
Short Term ◽  
Intrathecal Catheter ◽  
Content Type ◽  
Body Regions ◽  
Before And After ◽  
Generalized Dystonia ◽  
Fine Print

Generalized dystonia occurs in 15 to 25% of persons with cerebral palsy (CP) and responds poorly to medical and surgical treatments. Object. After the authors observed a woman whose dystonic CP was dramatically improved by continuous infusion of intrathecal baclofen, they designed this pilot study to evaluate the effect of this treatment on a group of patients with dystonic CP. Methods. The authors assessed the short-term response to intrathecal baclofen infusion in 12 patients with dystonic CP. An intrathecal catheter was inserted percutaneously and connected to an external microinfusion pump. The infusion began at a rate of 100 µg/day and was increased by 50 µg every 12 hours until the dystonia abated, adverse effects occurred, or the dose reached 900 mg/day with no improvement. Two observers, one blinded and one not blinded to the patient's treatment status, viewed videotapes made before and after the infusions and graded the dystonia in eight body regions, using a 5-point scale. Overall and regional scores were compared by using Wilcoxon signed-rank tests. Conclusions. Dystonia diminished in 10 of 12 patients whose average daily dose of intrathecal baclofen was 575 µg. Overall dystonia scores and scores for the extremities, trunk, and cervical regions were significantly better after infusion (p = 0.003). The two observers' scores were not significantly different. Programmable infusion pumps were subsequently implanted in eight patients for long-term therapy and improvement was sustained in six (p < 0.05). Intrathecal baclofen infusion is a promising treatment option for generalized dystonia associated with CP. The effects of intrathecal baclofen infusion on dystonia can be evaluated by using short-term continuous infusions.

Poster 442 Urinary Retention Secondary to an Intrathecal Baclofen Pump Placement: Case Report and Literature Review

PM&R ◽  
2011 ◽  
Vol 3 ◽  
pp. S328-S328
Author(s):  
Michelle Weiner ◽  
Seema R. Khurana ◽  
Jose Ramil O. Santos
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Urinary Retention ◽  
Intrathecal Baclofen ◽  
Pump Placement

Foreign Body Ingestion and Aspiration in the Pediatric Population: Analysis of 315 Cases

2013 ◽  
Vol 149 (2_suppl) ◽  
pp. P246-P246
Author(s):  
Anh Q. Truong ◽  
Jamie L. Funamura ◽  
Craig W. Senders
Keyword(s):  
Foreign Body ◽  
Population Analysis ◽  
Pediatric Population ◽  
Foreign Body Ingestion
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