Neural Tube Defect Effect of surgery timing on outcome

Abstract

Background: The optimal timing of postnatal surgical repair for myelomeningocele (MMC) remains controversial, particularly with regard to short‑term surgical and neurological outcomes.

Objective: To evaluate whether the exact time from birth to surgical repair, measured in hours, influences early postoperative complications, cerebrospinal fluid (CSF)–related outcomes, neurological status at discharge, and length of hospital stay.

Methods: A prospective cohort study was conducted involving 36 neonates with MMC who were enrolled at birth and followed through the early postoperative period. Exact timestamps of birth and surgical repair were recorded prospectively to calculate time to surgery as a continuous variable. Non‑parametric statistical analyses were applied. Outcomes included early postoperative infection (≤30 days), CSF‑related complications and revision surgery, neurological status at discharge, and duration of hospitalization.

Results:
The median time to surgical repair was 168 hours (interquartile range 164–488; range: 33–4,272 hours). No statistically significant associations were observed between time to surgery and early infection, revision‑related outcomes, neurological status at discharge, or length of hospital stay. Postoperative complications, irrespective of surgical timing, were significantly associated with prolonged hospitalization.

Conclusion: In this prospective cohort, short‑term outcomes following postnatal repair of MMC were not significantly influenced by the timing of surgery when analyzed as a continuous variable. These findings suggest that, within contemporary perioperative care frameworks, short‑term postoperative morbidity may be more strongly driven by complication burden than by exact timing of repair.