Does interfacility transfer affect outcomes in myelomeningocele repair? A National Surgical Quality Improvement Program Pediatric analysis.

Abstract

Objective: Myelomeningocele (MMC) remains one of the most common birth deformities, occurring in every 0.5 to 1 in 1000 pregnancies in the United States. Neonates born with MMC may require transfer to specialized institutions for surgical repair. This study aimed to investigate the impact of interfacility transfer on neonates undergoing MMC repair.

Methods: All MMC repair cases from 2015 to 2021 were extracted from the National Surgical Quality Improvement Program Pediatric database. Transferred and nontransferred cohorts were compared for associations between transfer status and postoperative complications. Stepwise regression was completed to identify predictors of adverse outcomes.

Results: From 2015 to 2021, 1672 MMC patients were identified, 753 of whom were transferred from an outside facility. Transferred patients were significantly more likely to be born vaginally (27.2% vs 18.9%, p = 0.005), premature (20.6% vs 15.3%, p = 0.033), and with low birth weight (16.7% vs 12.6%, p < 0.001). A greater number of transferred patients were classified as American Society of Anesthesiologists class III or higher (78.6% vs 73.2%, p = 0.009). Transferred patients were more frequently classified as an emergency (30.0% vs 19.2%, p < 0.001) or urgent (37.3% vs 24.9%, p < 0.001) case. Postoperatively, transferred patients were significantly more likely to experience cardiac arrest (0.9% vs 0.2%, p = 0.026), require supplemental oxygen at discharge (9.6% vs 4.8%, p < 0.001), have higher 30-day all-cause mortality (1.7% vs 0.5%, p = 0.020), and die more than 1 week after surgery (13 vs 3 deaths, p = 0.016).

Conclusions: Patients transferred in the neonatal period may experience worse postoperative outcomes after MMC repair. These data support a recommendation for patients prenatally diagnosed with MMC to be delivered at centers equipped for pre- and postnatal management, when possible.