Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
J Clin Neurosci. 2019 Dec;70:108-112. doi: 10.1016/j.jocn.2019.08.059. Epub 2019 Sep 3.
To describe 30-day outcomes following craniotomy for arteriovenous malformation in children and identify risk factors for readmission, reoperation, and perioperative complication using the National Surgical Quality Improvement Program (NSQIP) Pediatric database.
Patients aged 0-18 years who underwent surgery for arteriovenous malformations (years 2015-2016) were identified from the NSQIP Pediatric database. Descriptive statistics, uni-variate, and multi-variate regression analysis were performed using preoperative and perioperative data. The outcome of interest was postoperative adverse event including reoperation within 30 days, readmission within 30 days, discharge to rehab, and the complications wound infection/dehiscence, pneumonia, unplanned reintubation, pulmonary embolism (PE), renal insufficiency, urinary tract infection (UTI), stroke, venous thromboembolism (VT), and sepsis.
167 patients were identified who met study criteria. 58% were male, and the majority had an ASA classification of 3 or greater (68%). 96 (57%) patients were found to have a preoperative comorbidity, with the most common comorbidity being seizure disorder (54 patients, 32%). 76 patients (46%) had documented perioperative events or complications. The incidence of wound infection/dehiscence was 4%; and of pneumonia, PE, unplanned reintubation, renal insufficiency, UTI, stroke, VT, sepsis were <1%. There were no deaths. The incidence of unplanned reoperation was 10% and unplanned readmission was 12%. Most (90%) were discharged to home. Operative time (p = .0001, OR = 9.53), emergent surgery status (p = .0001, OR = 8.19) and preoperative comorbidities (p = .007) were found to be significant predictors of poor outcome.
In the NSQIP-P dataset, the incidence of perioperative complications and suboptimal outcomes among patients undergoing AVM resection were low.
利用国家手术质量改进计划（NSQIP）儿科数据库描述儿童动静脉畸形（AVM）开颅手术后 30 天的结果，并确定再入院、再次手术和围手术期并发症的风险因素。
从 NSQIP 儿科数据库中确定了 2015-2016 年接受 AVM 手术的 0-18 岁患者。使用术前和围手术期数据进行描述性统计、单变量和多变量回归分析。研究的主要结果为术后 30 天内发生的不良事件，包括再次手术、30 天内再次入院、出院至康复、以及伤口感染/裂开、肺炎、计划性再插管、肺栓塞（PE）、肾功能不全、尿路感染（UTI）、中风、静脉血栓栓塞（VT）和脓毒症等并发症。
共确定了 167 名符合研究标准的患者。58%为男性，大多数患者的美国麻醉师协会（ASA）分级为 3 级或更高（68%）。96 名（57%）患者术前存在合并症，最常见的合并症是癫痫（54 例，32%）。76 名（46%）患者记录了围手术期事件或并发症。伤口感染/裂开的发生率为 4%，肺炎、PE、计划性再插管、肾功能不全、UTI、中风、VT、脓毒症的发生率均<1%。无死亡病例。未计划再次手术的发生率为 10%，未计划再次入院的发生率为 12%。大多数（90%）患者出院回家。手术时间（p=0.0001，OR=9.53）、急诊手术状态（p=0.0001，OR=8.19）和术前合并症（p=0.007）是不良预后的显著预测因素。
在 NSQIP-P 数据集，AVM 切除术后患者的围手术期并发症和结局不佳的发生率较低。
