Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome
Purpose Surgery for children in developing nations is challenging. Endoscopic third ventriculostomy (ETV) is an important surgical treatment for childhood hydrocephalus and has been performed in developing nations, but with lower success rates than in developed nations. It is not known if the lower...
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| Veröffentlicht in: | Child's nervous system 2010-12, Vol.26 (12), p.1711-1717 |
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| creator | Kulkarni, Abhaya V Warf, Benjamin C Drake, James M Mallucci, Conor L Sgouros, Spyros Constantini, Shlomi |
| description | Purpose Surgery for children in developing nations is challenging. Endoscopic third ventriculostomy (ETV) is an important surgical treatment for childhood hydrocephalus and has been performed in developing nations, but with lower success rates than in developed nations. It is not known if the lower success rate is due to inherent differences in prognostic factors. Methods We analyzed a large cohort of children (≤20 years old) treated with ETV in developed nations (618 patients from Canada, Israel, United Kingdom) and developing nations of sub-Saharan Africa (979 patients treated in Uganda). Risk-adjusted survival analysis was performed. Results The risk of an intra-operative ETV failure (an aborted procedure) was significantly higher in Uganda regardless of risk adjustment (hazard ratio (HR), 95% confidence interval (CI), 11.00 (6.01 to 19.84) P |
| doi_str_mv | 10.1007/s00381-010-1195-x |
| format | Article |
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Endoscopic third ventriculostomy (ETV) is an important surgical treatment for childhood hydrocephalus and has been performed in developing nations, but with lower success rates than in developed nations. It is not known if the lower success rate is due to inherent differences in prognostic factors. Methods We analyzed a large cohort of children (≤20 years old) treated with ETV in developed nations (618 patients from Canada, Israel, United Kingdom) and developing nations of sub-Saharan Africa (979 patients treated in Uganda). Risk-adjusted survival analysis was performed. Results The risk of an intra-operative ETV failure (an aborted procedure) was significantly higher in Uganda regardless of risk adjustment (hazard ratio (HR), 95% confidence interval (CI), 11.00 (6.01 to 19.84) P < 0.001). After adjustment for patient prognostic factors and technical variation in the procedure (the use of choroid plexus cauterization), there was no difference in the risk of failure for completed ETVs (HR, 95% CI, 1.04 (0.83 to 1.29), P = 0.74). Conclusions Three factors account for all significant differences in ETV failure between Uganda and developed nations: patient prognostic factors, technical variation in the procedure, and intra-operatively aborted cases. Once adjusted for these, the response to completed ETVs of children in Uganda is no different than that of children in developed nations.</description><identifier>ISSN: 0256-7040</identifier><identifier>EISSN: 1433-0350</identifier><identifier>DOI: 10.1007/s00381-010-1195-x</identifier><identifier>PMID: 20552204</identifier><language>eng</language><publisher>Berlin/Heidelberg: Berlin/Heidelberg : Springer-Verlag</publisher><subject>Africa South of the Sahara - epidemiology ; Canada - epidemiology ; Child ; Child, Preschool ; Developed Countries - statistics & numerical data ; developing countries ; Developing Countries - statistics & numerical data ; endoscopy ; Humans ; hydrocephalus ; Hydrocephalus - mortality ; Hydrocephalus - surgery ; Infant ; Infant, Newborn ; Israel - epidemiology ; Kaplan-Meier Estimate ; Medicine ; Medicine & Public Health ; Neuroendoscopy - methods ; Neuroendoscopy - mortality ; Neurosciences ; Neurosurgery ; Original Paper ; Pediatrics ; Risk ; Risk adjustment ; Third Ventricle - surgery ; Treatment Failure ; Uganda - epidemiology ; United Kingdom - epidemiology ; Ventriculostomy - methods ; Ventriculostomy - mortality</subject><ispartof>Child's nervous system, 2010-12, Vol.26 (12), p.1711-1717</ispartof><rights>Springer-Verlag 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c399t-c46b534a188d9a661c93a9c705a8a345959bdb114bf76e66b91f72fe268c21dc3</citedby><cites>FETCH-LOGICAL-c399t-c46b534a188d9a661c93a9c705a8a345959bdb114bf76e66b91f72fe268c21dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00381-010-1195-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00381-010-1195-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20552204$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kulkarni, Abhaya V</creatorcontrib><creatorcontrib>Warf, Benjamin C</creatorcontrib><creatorcontrib>Drake, James M</creatorcontrib><creatorcontrib>Mallucci, Conor L</creatorcontrib><creatorcontrib>Sgouros, Spyros</creatorcontrib><creatorcontrib>Constantini, Shlomi</creatorcontrib><creatorcontrib>Canadian Pediatric Neurosurgery Study Group</creatorcontrib><creatorcontrib>and the Canadian Pediatric Neurosurgery Study Group</creatorcontrib><title>Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome</title><title>Child's nervous system</title><addtitle>Childs Nerv Syst</addtitle><addtitle>Childs Nerv Syst</addtitle><description>Purpose Surgery for children in developing nations is challenging. Endoscopic third ventriculostomy (ETV) is an important surgical treatment for childhood hydrocephalus and has been performed in developing nations, but with lower success rates than in developed nations. It is not known if the lower success rate is due to inherent differences in prognostic factors. Methods We analyzed a large cohort of children (≤20 years old) treated with ETV in developed nations (618 patients from Canada, Israel, United Kingdom) and developing nations of sub-Saharan Africa (979 patients treated in Uganda). Risk-adjusted survival analysis was performed. Results The risk of an intra-operative ETV failure (an aborted procedure) was significantly higher in Uganda regardless of risk adjustment (hazard ratio (HR), 95% confidence interval (CI), 11.00 (6.01 to 19.84) P < 0.001). After adjustment for patient prognostic factors and technical variation in the procedure (the use of choroid plexus cauterization), there was no difference in the risk of failure for completed ETVs (HR, 95% CI, 1.04 (0.83 to 1.29), P = 0.74). Conclusions Three factors account for all significant differences in ETV failure between Uganda and developed nations: patient prognostic factors, technical variation in the procedure, and intra-operatively aborted cases. Once adjusted for these, the response to completed ETVs of children in Uganda is no different than that of children in developed nations.</description><subject>Africa South of the Sahara - epidemiology</subject><subject>Canada - epidemiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Developed Countries - statistics & numerical data</subject><subject>developing countries</subject><subject>Developing Countries - statistics & numerical data</subject><subject>endoscopy</subject><subject>Humans</subject><subject>hydrocephalus</subject><subject>Hydrocephalus - mortality</subject><subject>Hydrocephalus - surgery</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Israel - epidemiology</subject><subject>Kaplan-Meier Estimate</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuroendoscopy - methods</subject><subject>Neuroendoscopy - mortality</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original Paper</subject><subject>Pediatrics</subject><subject>Risk</subject><subject>Risk adjustment</subject><subject>Third Ventricle - surgery</subject><subject>Treatment Failure</subject><subject>Uganda - epidemiology</subject><subject>United Kingdom - epidemiology</subject><subject>Ventriculostomy - methods</subject><subject>Ventriculostomy - mortality</subject><issn>0256-7040</issn><issn>1433-0350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUFv1DAUhC0EotvCD-ACvnEyvGfHccytqoAiVeKw9Gy9OE43SzYO9qbq_ntcpXCEk-U338xhhrE3CB8QwHzMAKpBAQgC0Wrx8IxtsFJKgNLwnG1A6loYqOCMnee8B0DdSPuSnUnQWkqoNixul3QX0on3MfHdqUvRh3lH45L5MPG8tGJLO0o08cs-DZ74fUi5iF24D2OcQ8cnOg5xyp848TTkn4K6_ZKPRfDxMFM5xYnHnsflWA7hFXvR05jD66f3gt1--fzj6lrcfP_67eryRnhl7VH4qm61qgibprNU1-itIusNaGpIVdpq23YtYtX2pg513VrsjeyDrBsvsfPqgr1fc-cUfy0hH91hyD6MI00hLtlZkMoYKfG_pLHW2KY0V0hcSZ9izin0bk7DgdLJIbjHQdw6iIPHfxnEPRTP26f0pT2E7q_jzwIFkCuQizSVKdw-Lmkq3fwz9d1q6ik6uislu9utBFSAtiBg1G8Z26DA</recordid><startdate>20101201</startdate><enddate>20101201</enddate><creator>Kulkarni, Abhaya V</creator><creator>Warf, Benjamin C</creator><creator>Drake, James M</creator><creator>Mallucci, Conor L</creator><creator>Sgouros, Spyros</creator><creator>Constantini, Shlomi</creator><general>Berlin/Heidelberg : Springer-Verlag</general><general>Springer-Verlag</general><scope>FBQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>20101201</creationdate><title>Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome</title><author>Kulkarni, Abhaya V ; Warf, Benjamin C ; Drake, James M ; Mallucci, Conor L ; Sgouros, Spyros ; Constantini, Shlomi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c399t-c46b534a188d9a661c93a9c705a8a345959bdb114bf76e66b91f72fe268c21dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Africa South of the Sahara - epidemiology</topic><topic>Canada - epidemiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Developed Countries - statistics & numerical data</topic><topic>developing countries</topic><topic>Developing Countries - statistics & numerical data</topic><topic>endoscopy</topic><topic>Humans</topic><topic>hydrocephalus</topic><topic>Hydrocephalus - mortality</topic><topic>Hydrocephalus - surgery</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Israel - epidemiology</topic><topic>Kaplan-Meier Estimate</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuroendoscopy - methods</topic><topic>Neuroendoscopy - mortality</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original Paper</topic><topic>Pediatrics</topic><topic>Risk</topic><topic>Risk adjustment</topic><topic>Third Ventricle - surgery</topic><topic>Treatment Failure</topic><topic>Uganda - epidemiology</topic><topic>United Kingdom - epidemiology</topic><topic>Ventriculostomy - methods</topic><topic>Ventriculostomy - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kulkarni, Abhaya V</creatorcontrib><creatorcontrib>Warf, Benjamin C</creatorcontrib><creatorcontrib>Drake, James M</creatorcontrib><creatorcontrib>Mallucci, Conor L</creatorcontrib><creatorcontrib>Sgouros, Spyros</creatorcontrib><creatorcontrib>Constantini, Shlomi</creatorcontrib><creatorcontrib>Canadian Pediatric Neurosurgery Study Group</creatorcontrib><creatorcontrib>and the Canadian Pediatric Neurosurgery Study Group</creatorcontrib><collection>AGRIS</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Child's nervous system</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kulkarni, Abhaya V</au><au>Warf, Benjamin C</au><au>Drake, James M</au><au>Mallucci, Conor L</au><au>Sgouros, Spyros</au><au>Constantini, Shlomi</au><aucorp>Canadian Pediatric Neurosurgery Study Group</aucorp><aucorp>and the Canadian Pediatric Neurosurgery Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome</atitle><jtitle>Child's nervous system</jtitle><stitle>Childs Nerv Syst</stitle><addtitle>Childs Nerv Syst</addtitle><date>2010-12-01</date><risdate>2010</risdate><volume>26</volume><issue>12</issue><spage>1711</spage><epage>1717</epage><pages>1711-1717</pages><issn>0256-7040</issn><eissn>1433-0350</eissn><abstract>Purpose Surgery for children in developing nations is challenging. Endoscopic third ventriculostomy (ETV) is an important surgical treatment for childhood hydrocephalus and has been performed in developing nations, but with lower success rates than in developed nations. It is not known if the lower success rate is due to inherent differences in prognostic factors. Methods We analyzed a large cohort of children (≤20 years old) treated with ETV in developed nations (618 patients from Canada, Israel, United Kingdom) and developing nations of sub-Saharan Africa (979 patients treated in Uganda). Risk-adjusted survival analysis was performed. Results The risk of an intra-operative ETV failure (an aborted procedure) was significantly higher in Uganda regardless of risk adjustment (hazard ratio (HR), 95% confidence interval (CI), 11.00 (6.01 to 19.84) P < 0.001). After adjustment for patient prognostic factors and technical variation in the procedure (the use of choroid plexus cauterization), there was no difference in the risk of failure for completed ETVs (HR, 95% CI, 1.04 (0.83 to 1.29), P = 0.74). Conclusions Three factors account for all significant differences in ETV failure between Uganda and developed nations: patient prognostic factors, technical variation in the procedure, and intra-operatively aborted cases. Once adjusted for these, the response to completed ETVs of children in Uganda is no different than that of children in developed nations.</abstract><cop>Berlin/Heidelberg</cop><pub>Berlin/Heidelberg : Springer-Verlag</pub><pmid>20552204</pmid><doi>10.1007/s00381-010-1195-x</doi><tpages>7</tpages></addata></record> |
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| subjects | Africa South of the Sahara - epidemiology Canada - epidemiology Child Child, Preschool Developed Countries - statistics & numerical data developing countries Developing Countries - statistics & numerical data endoscopy Humans hydrocephalus Hydrocephalus - mortality Hydrocephalus - surgery Infant Infant, Newborn Israel - epidemiology Kaplan-Meier Estimate Medicine Medicine & Public Health Neuroendoscopy - methods Neuroendoscopy - mortality Neurosciences Neurosurgery Original Paper Pediatrics Risk Risk adjustment Third Ventricle - surgery Treatment Failure Uganda - epidemiology United Kingdom - epidemiology Ventriculostomy - methods Ventriculostomy - mortality |
| title | Surgery for hydrocephalus in sub-Saharan Africa versus developed nations: a risk-adjusted comparison of outcome |
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