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Background <p>Spinal dysraphism (SD) requires lifelong multidisciplinary follow-up to prevent complications and optimize functional outcomes. In geographically fragmented healthcare systems, continuity of care may be challenging, particularly when patients cross regional or national borders to access specialized services. This study aimed to describe care trajectories and identify factors associated with optimal follow-up among children with SD managed in the southwestern Indian Ocean region.</p> Methods <p>We conducted a retrospective cohort study including children with SD who received active postnatal surgical management in the regional referral center of Reunion Island. Maternal, perinatal, clinical, and geographic characteristics were collected from hospital records. Optimal follow-up was defined according to the institutional multidisciplinary follow-up protocol.</p> Results <p>A total of 92 mother–infant dyads were included. Most pregnancies originated in Reunion Island (62.0%), followed by Mayotte (18.5%), the Comoros (16.3%), and Madagascar (3.3%). Prenatal diagnosis was established in 47.8% of pregnancies but varied substantially across territories. Surgical closure of the spinal defect was performed at a median age of 3&#xa0;days, and ventriculoperitoneal shunt placement was required in 44.6% of patients.</p> <p>Overall, 39 patients (42.4%) were lost to follow-up. Optimal follow-up was achieved in only 13 patients (14.1%). Geographic factors were strongly associated with follow-up outcomes. Patients residing in Reunion Island were significantly more likely to achieve optimal follow-up than those living outside the island (<i>p</i> = 0.04). In contrast, clinical characteristics—including lesion level, surgical timing, ventricular shunt placement, and functional outcomes—were not associated with follow-up status.</p> Conclusion <p>Continuity of care for children with SD in the southwestern Indian Ocean region is strongly influenced by geographic and health system factors. Despite successful initial surgical management, long-term follow-up remains limited for many patients living outside Reunion Island. Strengthening regional healthcare coordination and cross-border care pathways may help reduce disparities in access to long-term multidisciplinary care.</p>

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Care trajectories of children with spinal dysraphism treated in Reunion Island between 2006 and 2024

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月24日

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  • Etienne Suply,
  • Mialy Randrianarison,
  • Simon Lorrain,
  • Brahim Bouhmani,
  • Sébastien Freppel,
  • Pierre-Yves Robillard,
  • Silvia Iacobelli

摘要

Background

Spinal dysraphism (SD) requires lifelong multidisciplinary follow-up to prevent complications and optimize functional outcomes. In geographically fragmented healthcare systems, continuity of care may be challenging, particularly when patients cross regional or national borders to access specialized services. This study aimed to describe care trajectories and identify factors associated with optimal follow-up among children with SD managed in the southwestern Indian Ocean region.

Methods

We conducted a retrospective cohort study including children with SD who received active postnatal surgical management in the regional referral center of Reunion Island. Maternal, perinatal, clinical, and geographic characteristics were collected from hospital records. Optimal follow-up was defined according to the institutional multidisciplinary follow-up protocol.

Results

A total of 92 mother–infant dyads were included. Most pregnancies originated in Reunion Island (62.0%), followed by Mayotte (18.5%), the Comoros (16.3%), and Madagascar (3.3%). Prenatal diagnosis was established in 47.8% of pregnancies but varied substantially across territories. Surgical closure of the spinal defect was performed at a median age of 3 days, and ventriculoperitoneal shunt placement was required in 44.6% of patients.

Overall, 39 patients (42.4%) were lost to follow-up. Optimal follow-up was achieved in only 13 patients (14.1%). Geographic factors were strongly associated with follow-up outcomes. Patients residing in Reunion Island were significantly more likely to achieve optimal follow-up than those living outside the island (p = 0.04). In contrast, clinical characteristics—including lesion level, surgical timing, ventricular shunt placement, and functional outcomes—were not associated with follow-up status.

Conclusion

Continuity of care for children with SD in the southwestern Indian Ocean region is strongly influenced by geographic and health system factors. Despite successful initial surgical management, long-term follow-up remains limited for many patients living outside Reunion Island. Strengthening regional healthcare coordination and cross-border care pathways may help reduce disparities in access to long-term multidisciplinary care.