TY - JOUR
T1 - Surgical complications of intrathecal baclofen in children
T2 - A single centre, 20-year retrospective cohort study
AU - Bonouvrié, Laura A.
AU - Lagendijk, Karen E.
AU - Beckerman, Heleen
AU - Slot, K. Mariam
AU - van de Pol, Laura A.
AU - Buizer, Annemieke I.
N1 - Funding Information: We would like to thank Dr. W.J.R. van Ouwerkerk, who, as a neurosurgeon, is responsible for implantation of many of the implanted pumps in the patients of this study. Publisher Copyright: © 2022
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Introduction: Complications of intrathecal baclofen treatment (ITB) with an implanted pump can be severe and require surgery. Surgical implantation techniques and catheter materials for continuous ITB treatment have improved over the past years with the aim to reduce complications. Objective: To assess: 1) the type and rate of complications of ITB that require surgical intervention, 2) which risk factors influence the occurrence of complications, and, specifically, 3) whether complication rate is influenced by type of catheter used. Methods: A retrospective cohort study was conducted including all children (<18 years old) in one university medical center with pump implantation between 2001 and 2017. All complications requiring surgery were recorded. Risk factors for surgical intervention were determined using multiple logistic regression analysis. Catheter related complications between two types of catheters (silicone vs coated) were compared. Results: In total, 88 complications of ITB treatment requiring surgery were found in 47 (36.2%) out of 130 children. These included catheter-related complications (55.7% of all complications), infections (21.6%), cerebrospinal fluid leakage (14.8%), and pump-related complications (7.9%). The silicone catheter type, used until 2012, was found to be a significant risk factor for complications (Odds Ratio 3.75; 95% CI: 1.30–10.83). Since the introduction of the coated catheter type, in 2012, the rate of catheter-related complications decreased, from 0.15 to 0.10 complications per pump year. Conclusion: The rate of surgical complications of intrathecal baclofen in children is high, and most frequently catheter-related. The number of complications decreased since the introduction of a new, coated, catheter in 2012. This study helps to inform children and their caregivers about the risk of possible complications of ITB, and to identify directions for future improvement of ITB care.
AB - Introduction: Complications of intrathecal baclofen treatment (ITB) with an implanted pump can be severe and require surgery. Surgical implantation techniques and catheter materials for continuous ITB treatment have improved over the past years with the aim to reduce complications. Objective: To assess: 1) the type and rate of complications of ITB that require surgical intervention, 2) which risk factors influence the occurrence of complications, and, specifically, 3) whether complication rate is influenced by type of catheter used. Methods: A retrospective cohort study was conducted including all children (<18 years old) in one university medical center with pump implantation between 2001 and 2017. All complications requiring surgery were recorded. Risk factors for surgical intervention were determined using multiple logistic regression analysis. Catheter related complications between two types of catheters (silicone vs coated) were compared. Results: In total, 88 complications of ITB treatment requiring surgery were found in 47 (36.2%) out of 130 children. These included catheter-related complications (55.7% of all complications), infections (21.6%), cerebrospinal fluid leakage (14.8%), and pump-related complications (7.9%). The silicone catheter type, used until 2012, was found to be a significant risk factor for complications (Odds Ratio 3.75; 95% CI: 1.30–10.83). Since the introduction of the coated catheter type, in 2012, the rate of catheter-related complications decreased, from 0.15 to 0.10 complications per pump year. Conclusion: The rate of surgical complications of intrathecal baclofen in children is high, and most frequently catheter-related. The number of complications decreased since the introduction of a new, coated, catheter in 2012. This study helps to inform children and their caregivers about the risk of possible complications of ITB, and to identify directions for future improvement of ITB care.
KW - Baclofen pump
KW - Complications
KW - Dystonia
KW - ITB
KW - Spasticity
UR - http://www.scopus.com/inward/record.url?scp=85124556177&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejpn.2022.02.002
DO - https://doi.org/10.1016/j.ejpn.2022.02.002
M3 - Article
C2 - 35180559
SN - 1090-3798
VL - 37
SP - 94
EP - 97
JO - European Journal of Paediatric Neurology
JF - European Journal of Paediatric Neurology
ER -