Flexman Alana M, Merriman Bradley, Griesdale Donald E, Mayson Kelly, Choi Peter T, Ryerson Christopher J
*Department of Anesthesiology, Pharmacology and Therapeutics †Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC, Canada.
J Neurosurg Anesthesiol. 2014 Jul;26(3):198-204. doi: 10.1097/ANA.0b013e3182a43ed8.
Respiratory failure and death are devastating outcomes in the postoperative period. Patients undergoing neurosurgical procedures experience a greater frequency of respiratory failure compared with other surgical specialties. Resection of infratentorial mass lesions may be associated with an even higher risk because of several unique factors. Our objectives were: (1) to determine the incidence of postoperative respiratory failure and death in the neurosurgical population; and (2) to determine whether infratentorial procedures are associated with a higher risk compared with supratentorial procedures.
We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing intracranial tumor resection. The primary outcome was a composite of reintubation within 30 days, failure to wean from mechanical ventilation within 48 hours, and death within 30 days after surgery. We examined the association between the surgical site and the outcomes using multivariate logistic regression.
A total of 1699 patients met inclusion criteria (79% supratentorial and 21% infratentorial). The primary outcome occurred in 3.8% of supratentorial procedures and 6.6% of infratentorial procedures (P=0.02). Infratentorial tumor resection was independently associated with the composite outcome in the final model (odds ratio, 1.75; 95% confidence interval, 1.03-2.99; P=0.04) with the strongest association seen between infratentorial site and death (odds ratio, 2.44; 95% confidence interval, 1.23-4.87; P=0.01).
Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection. Mortality is an important contributor to this risk and should be a focus for future research.
呼吸衰竭和死亡是术后极具破坏性的后果。与其他外科专科相比，接受神经外科手术的患者发生呼吸衰竭的频率更高。由于一些独特因素，幕下肿块病变切除术的风险可能更高。我们的目标是：（1）确定神经外科患者术后呼吸衰竭和死亡的发生率；（2）确定幕下手术与幕上手术相比是否具有更高的风险。
我们回顾性分析了美国外科医师学会国家外科质量改进计划数据库，以确定接受颅内肿瘤切除术的患者。主要结局是术后30天内再次插管、48小时内无法脱离机械通气以及术后30天内死亡的综合情况。我们使用多因素逻辑回归分析手术部位与结局之间的关联。
共有1699例患者符合纳入标准（79%为幕上手术，21%为幕下手术）。幕上手术的主要结局发生率为3.8%，幕下手术为6.6%（P = 0.02）。在最终模型中，幕下肿瘤切除术与综合结局独立相关（比值比，1.75；95%置信区间，1.03 - 2.99；P = 0.04），幕下手术部位与死亡之间的关联最为显著（比值比，2.44；95%置信区间，1.23 - 4.87；P = 0.01）。
幕下神经外科手术是颅内肿瘤切除患者发生呼吸衰竭和死亡的独立危险因素。死亡率是这一风险的重要因素，应成为未来研究的重点。
