Kerezoudis Panagiotis, McCutcheon Brandon A, Murphy Meghan, Rayan Tarek, Gilder Hannah, Rinaldo Lorenzo, Shepherd Daniel, Maloney Patrick R, Hirshman Brian R, Carter Bob S, Bydon Mohamad, Meyer Fredric, Lanzino Giuseppe
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
Department of Neurosurgery, University of California at San Diego, San Diego, CA, USA.
Clin Neurol Neurosurg. 2016 Oct;149:75-80. doi: 10.1016/j.clineuro.2016.07.027. Epub 2016 Jul 27.
Large-scale studies examining the incidence and predictors of perioperative complications after surgical clipping of unruptured intracranial aneurysms (UIA) using nationally representative prospectively collected data are lacking in the literature.
Using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) dataset, we conducted a retrospective analysis of the complications experienced by patients that underwent surgical management of a UIA between the years of 2007 and 2013. The primary outcomes of interest were mortality within the 30-day perioperative period and adverse discharge disposition to a location other than home. Predictors of morbidity and mortality were elucidated using multivariable logistic regression analyses controlling for available patient demographic, comorbidity, and operative characteristics.
662 patients were identified in the ACS-NSQIP dataset for operative management of an unruptured aneurysm. The observed rates of 30-day mortality and adverse discharge disposition were 2.27% and 19.47%, respectively. A hundred and eight (16.31%) patients developed at least one major complication. On multivariable analysis, death within 30days was significantly associated with increased operative time (OR 1.005 per minute, 95% CI 1.002-1.008) and chronic preoperative corticosteroid use (OR 28.4, 95% CI 1.68-480.42), whereas major complication development was associated with increased operative time (OR 1.004 per minute, 95% CI 1.002-1.006), age (OR 1.017 per year, 95% CI 1-1.034), preoperative dependency (OR 3.3, 95% CI 1.16-9.40) and diabetes mellitus (OR 2.89, 95% CI 1.45-5.75). Lastly, increasing age (OR 1.017 per year, 95% CI 1-1.034) as well as ASA Class 3 (OR 1.73, 95% CI 1.08-2.77) and 4 (OR 2.28, 95% CI 1.1-4.72) were independent predictors of discharge to a location other than home.
Our study yields morbidity and mortality benchmarks for UIA surgery in a representative, national surgical registry. It will hopefully aid in recognizing those patients at greater risk for postoperative complications following surgical management, leading to appropriate changes in treatment strategies for this selected group of patients.
目前文献中缺乏使用具有全国代表性的前瞻性收集数据来研究未破裂颅内动脉瘤（UIA）手术夹闭术后围手术期并发症的发生率及预测因素的大规模研究。
利用美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据集，我们对2007年至2013年间接受UIA手术治疗的患者所经历的并发症进行了回顾性分析。主要关注的结局是围手术期30天内的死亡率以及出院时非回家的不良处置情况。使用多变量逻辑回归分析，控制可用的患者人口统计学、合并症和手术特征，以阐明发病和死亡的预测因素。
在ACS - NSQIP数据集中确定了662例接受未破裂动脉瘤手术治疗的患者。观察到的30天死亡率和不良出院处置率分别为2.27%和19.47%。108例（16.31%）患者发生了至少一种主要并发症。多变量分析显示，30天内死亡与手术时间延长（每分钟OR 1.005，95% CI 1.002 - 1.008）和术前长期使用皮质类固醇（OR 28.4，95% CI 1.68 - 480.42）显著相关，而主要并发症的发生与手术时间延长（每分钟OR 1.004，95% CI 1.002 - 1.006）、年龄（每年OR 1.017，95% CI 1 - 1.034）、术前依赖（OR 3.3，95% CI 1.16 - 9.40）和糖尿病（OR 2.89，95% CI 1.45 - 5.75）相关。最后，年龄增长（每年OR 1.017，95% CI 1 - 1.034）以及ASA分级3级（OR 1.73，95% CI 1.08 - 2.77）和4级（OR 2.28，95% CI 1.1 - 4.72）是出院时非回家的独立预测因素。
我们的研究在一个具有代表性的全国性手术登记系统中得出了UIA手术的发病率和死亡率基准。有望有助于识别那些手术治疗后发生术后并发症风险较高的患者，从而为这一特定患者群体的治疗策略带来适当改变。
