{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T00:44:17Z","timestamp":1768697057438,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The current pediatric neurosurgery capacity in lower-middle-income countries (LMICs) in South America is poorly understood. Correspondingly, the authors sought to interrogate the neurosurgical inpatient experience of the sole publicly funded pediatric hospital in one of the largest regional departments of Bolivia to better understand this capacity.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A retrospective review of all neurosurgical procedures performed at the Children\u2019s Hospital of La Paz, Bolivia (Hospital del Ni\u00f1o \"Dr. Ovidio Aliaga Uria\") between 2019 and 2023 was conducted after institutional approval using a recently implemented national electronic medical record system.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 475 neurosurgical admissions satisfied inclusion for analysis over the 5-year span. The majority of admissions were from within the La Paz Department (87%) via the emergency department (77%), without private insurance (83%). The most common indications for neurosurgical intervention were trauma (35%), followed by hydrocephalus (28%), congenital disease (12%), infection (5%), and craniosynostosis (3%). Overall, the median age at time of surgery was 2.0 years, and the median operating time was 1.5 hours with a minority of intraoperative complications (2%). The most common inpatient complication was unplanned return to the operating room (19%), most commonly seen in congenital indications. At final discharge, the median postoperative length of stay was 10 days. Twenty-seven (6%) of the 475 patients died during hospitalization, most commonly seen in tumor indications. Of the 448 patients who were discharged, 299 (67%) returned for at least one follow-up appointment.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>There is restricted breadth in neurosurgical indications and outcomes achievable at the Children\u2019s Hospital of La Paz, Bolivia. As such, the capacity of pediatric neurosurgery at institutions in LMICs in South America such as this one is very limited. Identifying and prioritizing actionable interventions to improve this capacity is institution- and LMIC-dependent, and as such, future efforts will need to be tailored appropriately.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.peds24126","type":"journal-article","created":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T02:04:03Z","timestamp":1716602643000},"page":"190-198","source":"Crossref","is-referenced-by-count":4,"title":["Assessing pediatric neurosurgery capacity in La Paz, Bolivia: an illustrative institutional experience of a lower-middle-income country in South America"],"prefix":"10.3171","volume":"34","author":[{"given":"Victor M.","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Hospital del Ni\u00f1o \"Dr. Ovidio Aliaga Uria,\" La Paz, Bolivia;"},{"name":"Department of Neurological Surgery, Nicklaus Children\u2019s Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Daniel","family":"Brun","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Hospital del Ni\u00f1o \"Dr. Ovidio Aliaga Uria,\" La Paz, Bolivia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toba N.","family":"Niazi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami; and"},{"name":"Department of Neurological Surgery, Nicklaus Children\u2019s Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge David","family":"Brun","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Hospital del Ni\u00f1o \"Dr. Ovidio Aliaga Uria,\" La Paz, Bolivia;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"The World Bank","article-title":"World Bank country and lending groups","unstructured":"World Bank country and lending groups. 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Neurosurgery. 2024;94(4):657\u2013665."},{"issue":"4","key":"b5","series-title":"J Neurosurg","first-page":"1065","article-title":"Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis","volume":"130","author":"Dewan MC","year":"2018","unstructured":"Dewan MC, Rattani A, Mekary R,  Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. 2018;130(4):1065\u20131079."},{"issue":"11","key":"b6","series-title":"Childs Nerv Syst","first-page":"3103","article-title":"Global, regional, and national epidemiological trends in neural tube defects between 1990 and 2019: a summary","volume":"39","author":"Lu VM","year":"2023","unstructured":"Lu VM. Global, regional, and national epidemiological trends in neural tube defects between 1990 and 2019: a summary. Childs Nerv Syst. 2023;39(11):3103\u20133109."},{"issue":"2","key":"b7","series-title":"Childs Nerv Syst","first-page":"445","article-title":"The epidemiologic associations of food availability with national incidence and mortality rates of pediatric central nervous system tumors","volume":"40","author":"Lu VM","year":"2024","unstructured":"Lu VM, Niazi TN. The epidemiologic associations of food availability with national incidence and mortality rates of pediatric central nervous system tumors. Childs Nerv Syst. 2024;40(2):445\u2013451."},{"key":"b8","series-title":"Surg Neurol Int","first-page":"123","article-title":"The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra","volume":"4","author":"Dabdoub CF","year":"2013","unstructured":"Dabdoub CF, Dabdoub CB. The history of neurosurgery in Bolivia and pediatric neurosurgery in Santa Cruz de la Sierra. Surg Neurol Int. 2013;4:123."},{"key":"b9","series-title":"Hospital del Ni\u00f1o","article-title":"Historia del Hospital del Ni\u00f1o","author":"Zamora GA","unstructured":"Zamora GA. Historia del Hospital del Ni\u00f1o. Hospital del Ni\u00f1o. Accessed April 2, 2024. https:\/\/www.hospitaldelnino.com.bo\/index.php\/hospital\/historia"},{"key":"b10","series-title":"Estado Plurinacional de Bolivia","article-title":"Censo Nacional de Poblaci\u00f3n y Vivienda 2012 Bolivia","unstructured":"Censo Nacional de Poblaci\u00f3n y Vivienda 2012 Bolivia. Estado Plurinacional de Bolivia. Accessed April 2, 2024. https:\/\/bolivia.unfpa.org\/sites\/default\/files\/pub-pdf\/Caracteristicas_de_Poblacion_2012.pdf"},{"key":"b11","series-title":"Instituto Nacional de Estad\u00edstica","article-title":"Resultados Censo Nacional de Poblaci\u00f3n y Vivienda 2012","unstructured":"Resultados Censo Nacional de Poblaci\u00f3n y Vivienda 2012. Instituto Nacional de Estad\u00edstica. 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J Neurosurg Pediatr. 2009;3(4):284\u2013295."},{"key":"b18","series-title":"Ministerio de Salud y Deportes","article-title":"Sistema \u00danico de Salud - preguntas frecuentes","unstructured":"Sistema \u00danico de Salud - preguntas frecuentes. Ministerio de Salud y Deportes. Accessed April 1, 2024. https:\/\/www.minsalud.gob.bo\/programas-de-salud\/sistema-unico-de-salud"},{"key":"b19","series-title":"Agencia Boliviana de Informaci\u00f3n","article-title":"Sistema \u00danico de Salud brind\u00f3 atenci\u00f3n m\u00e9dica a m\u00e1s de 6,5 millones de bolivianos desde el 2019","unstructured":"Sistema \u00danico de Salud brind\u00f3 atenci\u00f3n m\u00e9dica a m\u00e1s de 6,5 millones de bolivianos desde el 2019. Agencia Boliviana de Informaci\u00f3n. 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