Department of Neurosurgery, Neurological Institute, S-40, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
Department of Neurosurgery, Neurological Institute, S-40, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Clin Neurosci. 2014 Apr;21(4):623-32. doi: 10.1016/j.jocn.2013.09.001.
Ventriculostomy is a common neurosurgical procedure. We evaluated a large national sample of data regarding epidemiologic trends in neurosurgical practice relating to ventriculostomy. The USA Nationwide Inpatient Sample (1988 to 2010) provided retrospective data on patients hospitalized who underwent a ventriculostomy procedure. We categorized ventriculostomy procedures as the principal procedure performed for definitive treatment or as any other procedure. We identified 101,577 relevant hospital admissions with an estimated national volume of 507,762 hospital admissions from 1988 to 2010. For all patients, the mean age was 45.0 years and 46.5% were female. The three most common individual principal diagnoses were subarachnoid hemorrhage (19.1%), intracerebral hemorrhage (14.9%), and obstructive hydrocephalus (3.8%). The three most common principal procedures were other excision or destruction of lesion or tissue of brain (16.0%), clipping of aneurysm (13.5%), and temporary tracheostomy (10.8%). Mean length of stay was 20.8 days and in-hospital mortality was 24.5%. In-hospital mortality was associated with emergency admission (multivariate odds ratio 1.98; 95% confidence interval 1.92-2.05), age 45 years or greater (mean of data set) (1.91; 1.85-1.98), multiple ventriculostomies (1.55; 1.44-1.67), and ventriculostomy as a principal procedure (1.39; 1.35-1.44). A total of 32.7% of patients were discharged to home. Most (94.3%) hospitalizations had one, 5.0% had two, and 0.7% multiple (three or more) ventriculostomies performed. Neurosurgeons must be aware of the association of in-hospital mortality, especially during the first days of admission, particularly when ventriculostomy is the principal procedure performed for definitive treatment during the hospitalization.
脑室造口术是一种常见的神经外科手术。我们评估了大量关于神经外科实践中与脑室造口术相关的流行病学趋势的全国性数据。美国全国住院患者样本（1988 年至 2010 年）提供了关于接受脑室造口术的住院患者的回顾性数据。我们将脑室造口术分为主要手术以进行明确治疗或任何其他手术。我们确定了 101577 例相关住院治疗，估计 1988 年至 2010 年期间有 507762 例住院治疗。对于所有患者，平均年龄为 45.0 岁，46.5%为女性。三个最常见的主要个体诊断分别是蛛网膜下腔出血（19.1%）、脑内出血（14.9%）和阻塞性脑积水（3.8%）。三个最常见的主要手术分别是其他脑内病变或组织的切除或破坏（16.0%）、动脉瘤夹闭（13.5%）和临时气管切开术（10.8%）。平均住院时间为 20.8 天，院内死亡率为 24.5%。院内死亡率与紧急入院有关（多变量优势比 1.98；95%置信区间 1.92-2.05）、45 岁或以上年龄（数据集平均值）（1.91；1.85-1.98）、多次脑室造口术（1.55；1.44-1.67）和脑室造口术作为主要手术（1.39；1.35-1.44）。共有 32.7%的患者出院回家。大多数（94.3%）住院患者进行了一次手术，5.0%进行了两次手术，0.7%进行了多次（三次或更多次）脑室造口术。神经外科医生必须意识到院内死亡率的关联，尤其是在入院的头几天，特别是当脑室造口术是住院期间进行明确治疗的主要手术时。
