Discover how socioeconomic factors influence the surgical outcomes of prenatal versus postnatal myelomeningocele repair, shedding light on the intersection of health and wealth in functional neurosurgery.
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Socioeconomic characteristics and postoperative outcomes of patients undergoing prenatal vs. postnatal repair of myelomeningoceles.
Kalluri et al., Childs Nerv Syst 2023
DOI: 10.1007/s00381-023-06254-y
Study Summary:
A study compared the sociodemographic characteristics and short-term outcomes of patients undergoing prenatal versus postnatal myelomeningocele repair. The research involved 49 postnatal and 30 prenatal repair patients. It was found that those who had prenatal repair were more likely to have private insurance and lived further from the hospital. Importantly, prenatal repair was associated with shorter hospital stays, fewer complications, less emergency department visits within 30 days, lower cerebrospinal fluid (CSF) diversion rates, and better functional status at 3 months, 6 months, and 1 year post-surgery.
Key Results:
- Prenatal repair patients had a 73.3% rate of private insurance versus 42.9% in postnatal.
- They lived an average of 251.5 miles from the hospital, compared to 72.5 miles for postnatal.
- Hospital stays were 14.3 days for prenatal versus 25.3 days for postnatal.
- Complication rates were 13.8% for prenatal, 42.9% for postnatal.
- CSF diversion rates were 13.8% for prenatal, 38.8% for postnatal.
- Functional status showed less delay in prenatal at 3 months (13.3% vs. 57.1%), 6 months (20.0% vs. 56.7%), and 1 year (29.4% vs. 70.6%).
Importance:
This study highlights that prenatal myelomeningocele repair leads to significantly better short-term outcomes compared to postnatal repair. It also suggests that access to prenatal repair may be influenced by socioeconomic factors, such as insurance status and proximity to the hospital, which could be potential barriers to care.
Contribution to Literature:
The study contributes to the literature by providing evidence that prenatal repair is an independent predictor of better outcomes in myelomeningocele repair, and it underscores the need to address healthcare access disparities.