下丘脑错构瘤手术切除后住院并发症及预后的预测因素
Predictors of inpatient complications and outcomes following surgical resection of hypothalamic hamartomas.
作者信息
Mukherjee Debraj, Carico Christine, Nuño Miriam, Patil Chirag G
机构信息
Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048.
出版信息
Surg Neurol Int. 2011;2:105. doi: 10.4103/2152-7806.83387. Epub 2011 Jul 30.
BACKGROUND
Our aim was to identify the preoperative factors associated with a greater risk of poor inpatient outcomes in those undergoing resection of hypothalamic hamartomas.
METHODS
We performed a multi-institutional retrospective cohort analysis via the Nationwide Inpatient Sample (1998 - 2007). Patients of any age who underwent resection of hypothalamic hamartomas were identified by ICD-9 coding. The primary outcomes included inpatient complications, length of stay (LOS), and total charges. Multivariate regression models were constructed to analyze the outcomes.
RESULTS
Two hundred and eighty-two patients were identified with a mean age of 27.7 years, with most being male (53.2%), Caucasian (78.9%), privately insured (69.3%), and treated electively (74.7%) at academic centers (91.7%). A majority (82.2%) had Elixhauser comorbidity scores of < 1, indicating few comorbidities. No inpatient deaths were reported. Mean LOS was 7.39 days and the mean total hospital charges were $53,935. Overall, 19.5% developed an inpatient complication, primarily stroke (16.7%). Female gender, ethnic / racial minorities, higher comorbidity scores, private insurance, and non-academic hospitals were associated with greater LOS and total charges. Private insurance (Odds Ratio, OR: 1.59, P = 0.045) and academic hospitals (OR: 1.43, P = 0.008) were associated with significantly higher odds of any complication. Minority race / ethnicity was associated with a minimal increase in the odds of postoperative stroke (OR: 1.02, P < 0.001) relative to Caucasians.
CONCLUSIONS
Through an analysis of a 10-year multi-institutional database, we have described the surgical outcomes of patients undergoing resection of hypothalamic hamartomas. Results demonstrate significant inpatient morbidity, particularly postoperative stroke. Patient- and institution-level factors should be considered in determining the perioperative risk for such patients.
背景
我们的目的是确定下丘脑错构瘤切除术患者住院结局不佳风险较高的术前因素。
方法
我们通过全国住院患者样本（1998 - 2007年）进行了一项多机构回顾性队列分析。通过ICD - 9编码识别接受下丘脑错构瘤切除术的任何年龄患者。主要结局包括住院并发症、住院时间（LOS）和总费用。构建多变量回归模型以分析结局。
结果
共识别出282例患者，平均年龄27.7岁，大多数为男性（53.2%）、白种人（78.9%）、有私人保险（69.3%），并在学术中心（91.7%）接受择期治疗（74.7%）。大多数（82.2%）的埃利克斯豪泽合并症评分为<1，表明合并症较少。未报告住院死亡病例。平均住院时间为7.39天，平均总住院费用为53,935美元。总体而言，19.5%的患者出现住院并发症，主要是中风（16.7%）。女性、少数族裔/种族、较高的合并症评分、私人保险和非学术医院与更长的住院时间和更高的总费用相关。私人保险（优势比，OR：1.59，P = 0.045）和学术医院（OR：1.43，P = 0.008）与任何并发症的显著更高几率相关。相对于白种人，少数族裔种族与术后中风几率的最小增加相关（OR：1.02，P < 0.001）。
结论
通过对一个10年多机构数据库的分析，我们描述了接受下丘脑错构瘤切除术患者的手术结局。结果显示住院患者有显著的发病率，尤其是术后中风。在确定此类患者的围手术期风险时应考虑患者和机构层面的因素。
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