De la Garza Ramos Rafael, Goodwin C Rory, Nakhla Jonathan, Nasser Rani, Yassari Reza, Flamm Eugene S, Bydon Ali, Colby Geoffrey, Sciubba Daniel M
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgery. 2017 Sep 1;81(3):422-431. doi: 10.1093/neuros/nyx055.
Neurosurgical emergencies are an important cause of disability and mortality.
To examine the nationwide burden of neurological conditions requiring emergency neurosurgery.
The Nationwide Inpatient Sample database (2002-2011) was queried to identify adult patients with a primary discharge diagnosis of a neurosurgical condition who were admitted urgently/emergently or through a trauma center and underwent surgical intervention within 2 days of admission. Diagnostic groups were ranked based on their inpatient complication and mortality burden, and their contribution to total complications, deaths, hospital charges, and length of stay (LOS) was assessed. All analyses were weighted to produce national estimates.
After application of discharge weights, 810 404 patients who underwent emergency neurosurgery were identified. The average complication rate for the entire sample was 8.8%, the mortality rate was 11.2%, average charges were $106 802, and average LOS was 9.0 days. The top 4 diagnostic groups ranked by complication/mortality burden accounted for 76% of all complications, 96% of all deaths, 81% of all charges, and 82% of all days in the hospital for the entire study sample. This was equal to 62 648 complications, 86 683 deaths, $69 billion in charges, and 5962 932 days. These 4 diagnostic groups included (1) acute cerebrovascular disease, (2) intracranial injury, (3) spinal cord injury, and (4) occlusion or stenosis of precerebral arteries.
Acute cerebrovascular disease, intracranial injury, spinal cord injury, and occlusion/stenosis of precerebral arteries requiring emergency neurosurgery carry an important nationwide burden in terms of complications, deaths, charges, and LOS. Efforts in prevention and/or treatment of these conditions should continue.
神经外科急症是导致残疾和死亡的重要原因。
研究全国范围内需要急诊神经外科手术的神经系统疾病负担。
查询全国住院患者样本数据库（2002 - 2011年），以确定主要出院诊断为神经外科疾病的成年患者，这些患者通过急诊/紧急入院或通过创伤中心入院，并在入院后2天内接受手术干预。根据住院并发症和死亡率负担对诊断组进行排名，并评估它们对总并发症、死亡、住院费用和住院时间（LOS）的贡献。所有分析均进行加权以得出全国估计数。
应用出院权重后，确定了810404例接受急诊神经外科手术的患者。整个样本的平均并发症发生率为8.8%，死亡率为11.2%，平均费用为106802美元，平均住院时间为9.0天。按并发症/死亡率负担排名的前4个诊断组占整个研究样本所有并发症的76%、所有死亡的96%、所有费用的81%和所有住院天数的82%。这相当于62648例并发症、86683例死亡、690亿美元的费用和5962932天。这4个诊断组包括：（1）急性脑血管疾病，（2）颅内损伤，（3）脊髓损伤，（4）脑前动脉闭塞或狭窄。
需要急诊神经外科手术的急性脑血管疾病、颅内损伤、脊髓损伤以及脑前动脉闭塞/狭窄在并发症、死亡、费用和住院时间方面在全国范围内负担重大。应继续努力预防和/或治疗这些疾病。
