Comparison of open fetal, fetoscopic and postnatal surgical repair for open spina bifida: decision analysis
Notice bibliographique
Résumé
OBJECTIVE: Currently, there are several surgical approaches to manage fetal open spina bifida (OSB), namely postnatal surgical repair, open fetal surgery and its minimally invasive alternative, fetoscopic repair. Our objective was to determine the optimal surgical approach for OSB, weighing the benefits and risks to the fetus and the pregnant woman. METHODS: We assessed the health outcomes of open fetal, fetoscopic and postnatal surgical repair for pregnant women (mean ± SD age, 31 ± 3 years) with a singleton pregnancy and their offspring with OSB using a decision analytic model. We projected expected quality-adjusted life years (QALYs) associated with each of the interventions, discounted at 1.5% annually over the lifetime time horizon for pregnant women and their offspring. Secondary maternal outcomes during the pregnancy included delivery mode and complications such as chorioamnionitis, uterine dehiscence, placental abruption, pulmonary embolism and death. Offspring outcomes included preterm birth, perinatal and postnatal mortality, cerebrospinal fluid (CSF) diversion surgery by 12 months of age and wheelchair use at 30 months of age. Our model was populated using data from the published literature and by consultation with clinical experts. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Fetoscopic and open fetal surgery resulted in an identical number of expected QALYs (38.02 per mother-offspring dyad) and translated into a QALY gain of 1.70 per dyad compared with postnatal repair. With respect to QALYs gained, the probabilistic analyses showed that fetoscopic surgery was the preferred strategy in 51% of simulations, and open fetal surgery in the remaining 49% of simulations. When compared with postnatal repair, both open fetal and fetoscopic surgery showed that the gains in QALYs were most sensitive to the disutility associated with CSF diversion surgery and to the rate of wheelchair use. When comparing open fetal and fetoscopic approaches, the results were highly sensitive to the accuracy of all treatment effect estimates. CONCLUSION: In the management of fetal OSB, both fetoscopic and open fetal surgery demonstrate superior QALY gains compared with postnatal repair, largely related to a reduced number of individuals who use a wheelchair or require CSF diversion surgery. Given similar effectiveness of fetoscopic and open fetal surgery, an individual risk assessment is essential to guide decision-making between these two surgical approaches. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».