Cavalcante Daniel, Ormond D Ryan
Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
World Neurosurg. 2018 Jul;115:e782-e784. doi: 10.1016/j.wneu.2018.04.186. Epub 2018 May 3.
Postoperative hemorrhagic or ischemic complications cause significant morbidity and mortality after craniotomy. High altitude creates a state of relative hypoxia, resulting in increased cerebral blood flow for compensation. This potentially creates an increased risk at high altitude of having increased morbidity from hemorrhagic or ischemic events, and some neurosurgeons forbid air travel to patients immediately after craniotomy for this reason. We hypothesized there was no difference in postoperative complications based on altitude.
We retrospectively reviewed all craniotomies performed at a high-altitude medical center to assess whether originating, surgical, or destination altitude affected postoperative outcomes.
Between 1 July 2014 and 30 June 2016, 1807 craniotomy procedures were performed. There were 53 (2.9%) postoperative hemorrhagic or ischemic complications during the first 30 days after surgery, 44 (2.4%) hemorrhagic events, and 9 (0.5%) ischemic events. From the 36 patients who had postoperative complications at the hospital, 10 of them lived in an altitude below the hospital, 26 lived in an altitude above the hospital, and 1 has no record of address. Excluding the patients who had complications at the hospital, we had 8 patients discharged to a ZIP code below the altitude of the hospital (7 hemorrhagic events and 1 ischemic) and 9 were discharged to a location at an altitude above that of the hospital (8 hemorrhagic events and 1 ischemic). There were no statistically significant differences between cohorts.
Altitude does not appear to have a significant impact on postoperative rates of hemorrhagic or ischemic complications.
开颅术后出血性或缺血性并发症会导致显著的发病率和死亡率。高海拔会造成相对缺氧状态，导致脑血流量增加以进行代偿。这可能会增加在高海拔地区发生出血性或缺血性事件而导致发病率增加的风险，因此一些神经外科医生禁止开颅术后的患者立即乘坐飞机出行。我们假设海拔高度对术后并发症没有影响。
我们回顾性分析了一家高海拔医疗中心进行的所有开颅手术，以评估起始海拔、手术海拔或目的地海拔是否会影响术后结果。
在2014年7月1日至2016年6月30日期间，共进行了1807例开颅手术。术后30天内有53例（2.9%）发生出血性或缺血性并发症，其中44例（2.4%）为出血事件，9例（0.5%）为缺血事件。在医院发生术后并发症的36例患者中，10例居住在海拔低于医院的地区，26例居住在海拔高于医院的地区，1例无地址记录。排除在医院发生并发症的患者后，我们有8例患者出院至海拔低于医院的邮政编码地区（7例出血事件和1例缺血事件），9例出院至海拔高于医院的地区（8例出血事件和1例缺血事件）。各队列之间无统计学显著差异。
海拔高度似乎对术后出血性或缺血性并发症的发生率没有显著影响。
