Spinazzi Eleonora F, Shastri Darshan, Raikundalia Milap, Silva Nicole A, Eloy Jean Anderson, Liu James K
Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA.
Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
J Clin Neurosci. 2019 Jan;59:218-223. doi: 10.1016/j.jocn.2018.09.018. Epub 2018 Oct 9.
Surgical resection of meningiomas has been associated with high rates of venous thromboembolic events (VTE) as compared with all other intracranial tumors. There is a paucity of data regarding the clinical complications and comorbidities associated with this cohort yet the underlying pathophysiological mechanism for this tumor-specific finding remains unclear. Our goal was to determine the various impacts of VTE on meningioma surgery in a large cohort of inpatient admissions. This retrospective analysis utilized discharge data from the National Inpatient Sample (NIS) from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between patients with and without VTE. Of 20,259 patients, 426 (2.1%) experienced a VTE. Compared to the non-VTE cohort, patients that experienced a VTE were older (62.7 ± 13.7 vs. 57.2 ± 14.7; p < 0.001), were more commonly male (38.0% vs 30.1%; p = 0.001), had longer hospitalizations (18.8 vs 6.6 days; p < 0.001), and incurred significantly greater hospital charges ($195,837 vs $74,434; p < 0.001). VTE patients experienced significantly higher rates of acute postoperative complications including shock, hemorrhage, wound dehiscence, infection, intracerebral hemorrhage, hemiparesis/hemiplegia, stroke, and death during admission. Odds ratio of aforementioned postsurgical complications remained significantly higher both before and after adjusting for age and sex (all p < 0.01). Occurrence of VTE in patients undergoing meningioma resection portends greater hospital charges, most likely attributed to longer lengths of admission. Increased postoperative complications and mortality in the VTE group warrants further investigation and wariness of the surgeon when treating surgical candidates of meningioma.
与所有其他颅内肿瘤相比，脑膜瘤手术切除后发生静脉血栓栓塞事件（VTE）的几率很高。关于这一群体相关的临床并发症和合并症的数据很少，然而这一肿瘤特异性发现的潜在病理生理机制仍不清楚。我们的目标是在一大群住院患者中确定VTE对脑膜瘤手术的各种影响。这项回顾性分析利用了2002年至2010年国家住院患者样本（NIS）的出院数据。比较了有VTE和无VTE患者的人口统计学特征、合并症、住院时间、住院费用和术后并发症。在20259名患者中，426名（2.1%）发生了VTE。与非VTE队列相比，发生VTE的患者年龄更大（62.7±13.7岁对57.2±14.7岁；p<0.001），男性更常见（38.0%对30.1%；p=0.001），住院时间更长（18.8天对6.6天；p<0.001），住院费用显著更高（195837美元对74434美元；p<0.001）。VTE患者急性术后并发症的发生率显著更高，包括休克、出血、伤口裂开、感染、脑出血、偏瘫/半身不遂、中风和住院期间死亡。在调整年龄和性别后，上述术后并发症的比值比仍然显著更高（所有p<0.01）。脑膜瘤切除患者发生VTE预示着更高的住院费用，这很可能归因于更长的住院时间。VTE组术后并发症和死亡率的增加值得进一步研究，并且在治疗脑膜瘤手术候选患者时外科医生应保持警惕。
