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前庭神经鞘瘤手术患者30天非神经学发病率和脑脊液漏的危险因素

Risk Factors for 30-Day Non-Neurological Morbidity and Cerebrospinal Fluid Leak in Patients Undergoing Surgery for Vestibular Schwannoma.

作者信息

Gelfand Yaroslav, Longo Michael, Berezin Naomi, Nakhla Jonathan P, De la Garza-Ramos Rafael, Agarwal Vijay

机构信息

Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Ce/Snter/Albert Einstein College of Medicine, Bronx, New York, Unites States.

Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, United States.

出版信息

J Neurol Surg B Skull Base. 2020 Oct;81(5):546-552. doi: 10.1055/s-0039-1692478. Epub 2019 Jun 21.

Abstract

We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of cerebrospinal fluid (CSF) leaks that required surgery.  Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 using current procedural terminology (CPT) codes for posterior fossa surgical approaches and International Classification of Diseases 9th revision (ICD 9) and ICD 10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with CSF leaks and unplanned returns to the operating room.  Nine-hundred ninety-three patients fit the inclusion criteria. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 1.9-16.6,  = 0.001), preoperative anemia (OR: 2.4, 95% CI: 1.2-4.5,  = 0.009), and operative time over 8 hours (OR: 1.9, 95% CI: 1.1-3.4,  = 0.017) were the only significant predictors of perioperative complications. CSF leak postoperatively occurred in 37 patients (3.7%). Reoperation for CSF leak was necessary in 56.3% of the cases. Operative time over 8 hours was the only independent significant predictor of postoperative CSF leak (OR: 2.2, 95% CI: 1.1-4.3,  = 0.028).  Dependent functional status preoperatively, preoperative anemia, and duration of surgery over 8 hours are the greatest predictors of complications in the 30-day postoperative period.

摘要

我们分析了接受前庭神经鞘瘤手术干预患者的围手术期发病和死亡风险因素,以及需要手术治疗的脑脊液(CSF)漏发生率。

使用后颅窝手术入路的当前手术操作术语(CPT)编码以及周围神经鞘瘤的国际疾病分类第9版(ICD - 9)和ICD - 10编码,从2012年至2016年美国外科医师学会国家外科质量改进计划数据库中识别出接受前庭神经鞘瘤手术的患者。分析了术前实验室检查结果、合并症、手术时间以及脑脊液漏和非计划重返手术室的情况。

993例患者符合纳入标准。平均年龄为51岁,41%为男性,58%为女性。术后30天内死亡率极低,为0.4%,并发症发生率为7%,其中感染最为常见,为2.3%,7.4%的病例发生了非计划再次手术。依赖性功能状态(优势比[OR]:5.7,95%置信区间[CI]:1.9 - 16.6,P = 0.001)、术前贫血(OR:2.4,95%CI:1.2 - 4.5,P = 0.009)和手术时间超过8小时(OR:1.9,95%CI:1.1 - 3.4,P = 0.017)是围手术期并发症的唯一显著预测因素。术后脑脊液漏发生在37例患者中(3.7%)。56.3%的病例需要因脑脊液漏进行再次手术。手术时间超过8小时是术后脑脊液漏的唯一独立显著预测因素(OR:2.2,95%CI:1.1 - 4.3,P = 0.028)。

术前依赖性功能状态、术前贫血和手术时间超过8小时是术后30天内并发症的最大预测因素。

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