Reponen Elina, Korja Miikka, Niemi Tomi, Silvasti-Lundell Marja, Hernesniemi Juha, Tuominen Hanna
Departments of 1 Anaesthesiology and Intensive Care Medicine, and.
Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; and.
J Neurosurg. 2015 Sep;123(3):594-604. doi: 10.3171/2014.11.JNS141970. Epub 2015 May 1.
Patients undergoing craniotomy are routinely assessed preoperatively, yet the role of these assessments in predicting outcome is poorly studied. This study aimed to identify preoperative factors predicting in-hospital outcome after cranial neurosurgery.
The study cohort consisted of 418 consecutive adults undergoing elective craniotomy for any intracranial lesion. Apart from the age criteria (≥ 18 years), almost all patients were considered eligible for the study to increase external validity of the results. The studied preoperative assessments included various patient-related data, routine blood tests, American Society of Anesthesiologists (ASA) Physical Status Classification system, and a local modification of the ASA classification (Helsinki ASA classification). Adverse outcomes were in-hospital mortality, in-hospital systemic or infectious complications, and in-hospital CNS deficits. Resource use was defined as length of stay (LOS) in the intensive care unit and overall LOS in the hospital.
The in-hospital mortality rate was 1.0%. In-hospital systemic or infectious complications and permanent or transient CNS deficits occurred in 6.7% and 11.2% of the patients, respectively. Advanced age (≥ 60-65 years), elevated C-reactive protein level (> 3 mg/L), and high Helsinki ASA score (Class 4) were associated with in-hospital systemic and infectious complications, and a combination of these could identify one-fourth of the patients with postoperative complications. Moreover, this combination of preoperative assessment parameters was significantly associated with increased resource use.
In this first prospective and unselected cohort study of outcome after elective craniotomy, simple preoperative assessments identified patients with a high risk of in-hospital systemic or infectious complications as well as extended resource use. Presented risk assessment methods may be widely applicable, also in low-volume centers, as they are based on composite predictors and outcome events.
接受开颅手术的患者通常会在术前进行常规评估，但这些评估在预测手术结果方面的作用尚未得到充分研究。本研究旨在确定预测颅脑神经外科手术后住院结局的术前因素。
研究队列包括418例因任何颅内病变接受择期开颅手术的连续成年患者。除年龄标准（≥18岁）外，几乎所有患者均被认为符合研究条件，以提高结果的外部有效性。所研究的术前评估包括各种与患者相关的数据、常规血液检查、美国麻醉医师协会（ASA）身体状况分类系统以及ASA分类的局部修改（赫尔辛基ASA分类）。不良结局包括住院死亡率、住院期间的全身或感染性并发症以及住院期间的中枢神经系统缺陷。资源使用定义为重症监护病房的住院时间（LOS）和医院的总住院时间。
住院死亡率为1.0%。住院期间的全身或感染性并发症以及永久性或暂时性中枢神经系统缺陷分别发生在6.7%和11.2%的患者中。高龄（≥60 - 65岁）、C反应蛋白水平升高（>3 mg/L）和高赫尔辛基ASA评分（4级）与住院期间的全身和感染性并发症相关，这些因素的组合可识别出四分之一的术后并发症患者。此外，术前评估参数的这种组合与资源使用增加显著相关。
在这项关于择期开颅手术后结局的首次前瞻性且未经过筛选的队列研究中，简单的术前评估可识别出住院期间发生全身或感染性并发症以及资源使用增加风险较高的患者。所提出的风险评估方法可能具有广泛的适用性，在低容量中心也同样适用，因为它们基于综合预测指标和结局事件。
