Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
World Neurosurg. 2019 Jun;126:e1147-e1154. doi: 10.1016/j.wneu.2019.03.058. Epub 2019 Mar 15.
There is sparse literature that investigates the adverse effects of postoperative pulmonary complication (PPCs) specifically in postcraniotomy tumor patients. In this study, we describe the rate of PPCs, determine predictive factors, and delineate associations with adverse outcomes.
The National Surgical Quality Improvement Program (2006-2016) database was queried for patients who underwent craniotomy for brain tumors. A total of 28,700 eligible patients were identified. Univariate tests and/or multivariate logistic regression were used to determine predictors of PPC and associations with adverse outcomes.
A total of 19 predictors of PPC across 14 different categories were identified: age 65-79 years (odds ratio [OR] 1.6; P < 0.001), age ≥80 years (OR 2.3; P < 0.001), male sex (OR 1.3; P < 0.001), operative time ≥360 minutes (OR 4.3; P < 0.001), operative time 300-359 minutes (OR 2.5; P < 0.001), operative time 240-299 minutes (OR 1.8; P < 0.001), operative time 180-239 minutes (OR 1.3; P < 0.001), total functional dependence (OR 3.8; P < 0.001), partial functional dependence (OR 1.7; P < 0.001), insulin-dependent diabetes (OR 1.5; P < 0.001), preoperative dyspnea (OR 1.3; P = 0.01), chronic steroid use (OR 1.4; P < 0.001), chronic obstructive pulmonary disease (OR 1.8; P < 0.001), preoperative leukocytosis (OR 1.4; P < 0.001), anemia (OR 1.2; P < 0.001), American Society of Anesthesiologists (ASA) classification ≥3 (OR 2.0; P < 0.001), emergency case status (OR 2.0; P < 0.001), and infratentorial lesions (OR 1.4; P < 0.001). PPCs were significantly associated with higher reoperation, readmission, and mortality rates as well as longer length of stay (univariate).
There are several predictive factors of PPCs in patients that undergo surgical resection of brain tumors, and PPC development is associated with numerous adverse outcomes. It is critically important to understand and, if possible, mitigate controllable circumstances that may reduce morbidity and mortality associated with PPCs.
针对术后肺部并发症（PPC），尤其是颅脑手术后肿瘤患者的不良影响，文献记载较少。本研究旨在描述 PPC 发生率，确定预测因素，并阐明其与不良结局的关系。
对 2006 年至 2016 年国家手术质量改进计划数据库中接受开颅手术治疗脑肿瘤的患者进行查询。共确定了 28700 名符合条件的患者。采用单变量检验和/或多变量逻辑回归确定 PPC 的预测因素，并分析与不良结局的关联。
确定了 19 个与 14 个不同类别相关的 PPC 预测因素：年龄 65-79 岁（优势比[OR] 1.6；P < 0.001）、年龄≥80 岁（OR 2.3；P < 0.001）、男性（OR 1.3；P < 0.001）、手术时间≥360 分钟（OR 4.3；P < 0.001）、手术时间 300-359 分钟（OR 2.5；P < 0.001）、手术时间 240-299 分钟（OR 1.8；P < 0.001）、手术时间 180-239 分钟（OR 1.3；P < 0.001）、完全功能依赖（OR 3.8；P < 0.001）、部分功能依赖（OR 1.7；P < 0.001）、胰岛素依赖型糖尿病（OR 1.5；P < 0.001）、术前呼吸困难（OR 1.3；P = 0.01）、长期使用类固醇（OR 1.4；P < 0.001）、慢性阻塞性肺疾病（OR 1.8；P < 0.001）、术前白细胞增多（OR 1.4；P < 0.001）、贫血（OR 1.2；P < 0.001）、美国麻醉医师协会（ASA）分级≥3（OR 2.0；P < 0.001）、急症病例状态（OR 2.0；P < 0.001）和幕下病变（OR 1.4；P < 0.001）。PPC 与更高的再手术、再入院和死亡率以及更长的住院时间显著相关（单变量）。
颅脑肿瘤切除术患者存在多种 PPC 预测因素，PPC 发生与多种不良结局相关。了解并尽可能减轻可能降低与 PPC 相关的发病率和死亡率的可控因素至关重要。
