Departments of Neurosurgery.
Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA.
J Neurosurg Anesthesiol. 2018 Oct;30(4):328-336. doi: 10.1097/ANA.0000000000000474.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was used to establish predictors for 30-day postoperative complications following spine and cranial neurosurgery.
The ACS-NSQIP participant use files were queried for neurosurgical cases between 2005 and 2015. Prevalence of postoperative complications following neurosurgery was determined. Nested multivariable logistic regression analysis was used to identify demographic, comorbidity, and perioperative characteristics associated with any complication and mortality for spine and cranial surgery.
There were 175,313 neurosurgical cases (137,029 spine, 38,284 cranial) identified. A total of 23,723 (13.5%) patients developed a complication and 2588 (1.5%) patients died. Compared with spine surgery, cranial surgery had higher likelihood of any complication (22.2% vs. 11.1%; P<0.001) and mortality (4.8% vs. 0.5%; P<0.001). In multivariable analysis, cranial surgery had 2.73 times higher likelihood for mortality compared with spine surgery (95% confidence interval, 2.46-3.03; P<0.001), but demonstrated lower odds of any complication (odds ratio, 0.93; 95% confidence interval, 0.90-0.97; P<0.001). There were 6 predictors (race, tobacco use, dyspnea, chronic obstructive pulmonary disease, chronic heart failure, and wound classification) significantly associated with any complication, but not mortality. Paradoxically, tobacco use had an unexplained protective effect on at least one complication or any complication. Similarly, increasing body mass index was protective for any complication and mortality, which suggests there may be a newly observed "obesity paradox" in neurosurgery.
After controlling for demographic characteristics, preoperative comorbidities, and perioperative factors, cranial surgery had higher risk for mortality compared with spine surgery despite lower risk for other complications. These findings highlight a discrepancy in the risk for postoperative complications following neurosurgical procedures that requires emphasis within quality improvement initiatives.
美国外科医师学会国家外科质量改进计划（ACS-NSQIP）用于确定脊柱和颅神经外科术后 30 天内发生并发症的预测因素。
查询 2005 年至 2015 年期间 ACS-NSQIP 参与者使用文件中的神经外科病例。确定神经外科手术后并发症的发生率。使用嵌套多变量逻辑回归分析确定与脊柱和颅部手术任何并发症和死亡率相关的人口统计学、合并症和围手术期特征。
共确定了 175313 例神经外科病例（137029 例脊柱手术，38284 例颅部手术）。共有 23723 例（13.5%）患者发生并发症，2588 例（1.5%）患者死亡。与脊柱手术相比，颅部手术发生任何并发症的可能性更高（22.2%比 11.1%；P<0.001）和死亡率（4.8%比 0.5%；P<0.001）。多变量分析显示，颅部手术的死亡率是脊柱手术的 2.73 倍（95%置信区间，2.46-3.03；P<0.001），但并发症的可能性较低（比值比，0.93；95%置信区间，0.90-0.97；P<0.001）。有 6 个预测因素（种族、吸烟、呼吸困难、慢性阻塞性肺疾病、慢性心力衰竭和伤口分类）与任何并发症显著相关，但与死亡率无关。矛盾的是，吸烟对至少一种或任何并发症都有意外的保护作用。同样，体重指数增加对任何并发症和死亡率都有保护作用，这表明神经外科中可能存在新的“肥胖悖论”。
在控制人口统计学特征、术前合并症和围手术期因素后，颅部手术的死亡率高于脊柱手术，尽管其他并发症的风险较低。这些发现突出了神经外科手术后并发症风险的差异，这需要在质量改进计划中强调。
