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Background Post-operative Emergency Department (ED) visits following suboccipital decompression in CM-1 patients are not well described. We sought to evaluate the magnitude, etiology, and significance of post-operative ED service utilization in adult CM-1 patients at a tertiary referral center. Methods A prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was also compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS). Results In 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%), and concentration disturbance at presentation was the only factor significantly associated with a post-operative ED visit (p=0.023). The occurrence of a post-operative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted OR of CCOS≥13=0.35, p=0.021; adjusted OR of CCOS≥14=0.38, p=0.016). Conclusion Adult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of post-operative ED visits, which are mostly due to pain-related complaints. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of post-operative ED service utilization are warranted.
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10.1016/j.wneu.2020.09.068
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document_parses/pdf_json/470336bcc9321dc05ad1ce2aa2c8317dc07c68f3.json
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Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I
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