Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
World Neurosurg. 2021 May;149:e415-e426. doi: 10.1016/j.wneu.2021.02.008. Epub 2021 Feb 25.
This study aims to examine the risk factors that can cause intraoperative rupture (IOR), and especially, the role of surgical experience. To our knowledge, this is the first study to analyze the effect of the surgeon's experience on the IOR rate in 2 different perspectives.
A total of 1000 aneurysms in 775 patients were operated on by a single neurosurgeon. The clinical and radiologic data and intraoperative video recordings of all patients were retrospectively analyzed. To evaluate the role of the surgeon's experience on the IOR rate, the aneurysms were divided chronologically into both 5-year periods and each 100 aneurysms. Number, stage, severity, location, management of IORs, and patients' outcomes were determined.
IOR occurred in 55 aneurysms (5.5% per aneurysm). The incidence of IOR decreased gradually in the first 2 groups of 5-year periods (11.4% and 5.9%, respectively). However, in the last 3 groups, the decline remained stable (4%-5%). Considering all groups, this decrease was statistically significant (P = 0.037). When this evaluation was made for each group of 100 aneurysms, similar results were obtained. Mortality also gradually decreased over the years (P = 0.035). Of 8 possible risk factors, rupture status was found to be the only independent predictor for IOR (OR, 8.68; 95% confidence interval, 3.69-20.47; P <0.001).
Increased surgical experience reduces the IOR rate from 10%-11% to 4%-5% after an average of 250 aneurysm operations. However, this rate does not decrease further with more experience. To our knowledge, a learning curve regarding IOR is presented for the first time in the literature.
本研究旨在探讨术中破裂（IOR）的危险因素，特别是手术经验的作用。据我们所知，这是首次从 2 个不同角度分析外科医生经验对 IOR 发生率的影响的研究。
对 1 名神经外科医生进行的 775 例患者的 1000 个动脉瘤进行了回顾性分析。所有患者的临床和影像学数据以及术中视频记录均进行了回顾性分析。为了评估外科医生经验对 IOR 发生率的影响，将动脉瘤按照 5 年时间分为两组，每组 100 个动脉瘤。确定动脉瘤的数量、分期、严重程度、位置、IOR 的处理以及患者的结局。
IOR 发生在 55 个动脉瘤中（每个动脉瘤的发生率为 5.5%）。在最初的 2 组 5 年期间，IOR 的发生率逐渐降低（分别为 11.4%和 5.9%）。然而，在最后 3 组中，下降趋势保持稳定（4%-5%）。考虑到所有组，这种下降具有统计学意义（P=0.037）。当按每组 100 个动脉瘤进行评估时，也得到了类似的结果。死亡率也随着时间的推移逐渐降低（P=0.035）。在 8 个可能的危险因素中，破裂状态被发现是 IOR 的唯一独立预测因子（OR，8.68；95%置信区间，3.69-20.47；P<0.001）。
在平均进行 250 个动脉瘤手术后，手术经验的增加将 IOR 发生率从 10%-11%降低至 4%-5%。然而，随着经验的增加，该比率不会进一步降低。据我们所知，首次在文献中提出了关于 IOR 的学习曲线。
