1. 2012;15;65-74Rising Complication Rates after Intrathecal Catheter and Pump Placement in the Pediatric Population: Analysis of National Data between 1997 and 2006
   Observational Study
   Zhiyi Zuo, MD,PhD, and Narayana C Varhabhatla, MD.

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.