Bartek Jiri, Sjåvik Kristin, Förander Petter, Solheim Ole, Gulati Sasha, Weber Clemens, Ingebrigtsen Tor, Jakola Asgeir S
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway.
World Neurosurg. 2015 May;83(5):673-8. doi: 10.1016/j.wneu.2015.01.022. Epub 2015 Feb 3.
To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events.
A retrospective review was conducted in a Scandinavian population-based cohort of 979 adult operations for intracranial meningioma performed at 3 neurosurgical centers with population-based referral between January 1, 2007, and June 30, 2013. Possible predictors of severe complications were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable model.
Severe complications were observed in 68 (7%) operations. Univariable analyses identified patient age >70 years (P < 0.001), male sex (P = 0.03), Charlson Comorbidity Index >1 (P = 0.02), Simpson grade >3 (P = 0.03), Karnofsky performance scale score <70 (P < 0.001), and duration of surgery >4 hours (P < 0.001) as significant predictors of severe complications. Age >70 (odds ratio = 2.5, P < 0.01), duration of surgery >4 hours (odds ratio = 3.2, P < 0.001), and Karnofsky performance scale score <70 (odds ratio = 2.5, P < 0.01) were independent predictors of severe complications in the multivariable regression analysis.
Severe complications after meningioma resection are more encountered often in elderly patients (>70 years old), dependent patients (Karnofsky performance scale score <70), and patients who underwent longer lasting surgery (>4 hours). Patient selection, including careful consideration of the individual risk-benefit ratio, is important in improving the safety of intracranial meningioma resection.
使用不良事件标准化报告系统，调查颅内脑膜瘤切除术后并发症的预测因素。
对斯堪的纳维亚地区以人群为基础的队列进行回顾性研究，该队列包括2007年1月1日至2013年6月30日期间在3个神经外科中心进行的979例成人颅内脑膜瘤手术，这些手术基于人群转诊。在单变量分析中确定并分析严重并发症的可能预测因素。P值<0.10的变量纳入多变量模型。
68例（7%）手术出现严重并发症。单变量分析确定患者年龄>70岁（P<0.001）、男性（P=0.03）、Charlson合并症指数>1（P=0.02）、Simpson分级>3（P=0.03）、卡氏功能状态评分<70（P<0.001）以及手术时间>4小时（P<0.001）为严重并发症的显著预测因素。在多变量回归分析中，年龄>70（比值比=2.5，P<0.01）、手术时间>4小时（比值比=3.2，P<0.001）和卡氏功能状态评分<70（比值比=2.5，P<0.01）是严重并发症的独立预测因素。
脑膜瘤切除术后严重并发症在老年患者（>70岁）、依赖患者（卡氏功能状态评分<70）以及手术时间较长（>4小时）的患者中更常出现。在改善颅内脑膜瘤切除安全性方面，包括仔细考虑个体风险效益比的患者选择很重要。
