Department of Neurosurgery, Aix-Marseille University, APHM, CHU Timone, Marseille, France -
Inserm, INS, Institute of Neurosciences of Systems, Aix Marseille University, Marseille, France -
J Neurosurg Sci. 2023 Apr;67(2):157-167. doi: 10.23736/S0390-5616.21.05083-9. Epub 2021 Mar 11.
Postoperative complications do occur in all neurosurgical departments, but the way they are defined, and their true incidence vary a lot. The aim of the present study was to objectively assess the morbidity and mortality related to all neurosurgical procedures performed in our department and provide insight on their main causes and identify key factors to reduce their incidence.
Data were retrieved from a prospectively maintained database regarding all patients undergoing a cranial or spinal neurosurgical procedure between November 2016 and April 2016 in the neurosurgical department in Timone University Hospital (APHM- Marseille). Patients undergoing a functional, pediatric, or interventional neuroradiological procedures were not included.
The medical records of a total number of 963 patients were analyzed. A postoperative complication occurred in 208 patients (21.6%) including 115 (26.6%) in the cranial surgery group and 93 (17.5%) in the spinal surgery group. A complication occurred 1.5 more frequently in the cranial than in the spinal surgery group. Cranial surgery is 1.5 times more at risk of complications than spinal surgery (P=0.007). Preoperative comorbidities (ASA Score >3 to 4) were significantly associated with the occurrence of complications (P<0.001). In the cranial group, procedures performed in an emergency setting were 1.8 times more at risk of complications than scheduled surgeries (P<0.001). Conversely, in the spine group, scheduled surgeries were 1.4 times less at risk than emergency procedures (P=0.04). The main complication in both groups was found to be postoperative infection, with an incidence of 9.3% and 11.1% for cranial and spinal surgery respectively. Postoperative mortality reached 4.9% and 1.7% and the average length of stay was 12 and 11 days respectively.
The incidence of complication in our series was found to be relatively high with predominantly infection as the main cause of postoperative complications. Reinforcing good practice measures at every step should help to significantly decrease our complication rate.
所有神经外科科室都会发生术后并发症，但并发症的定义方式及其实际发生率差异很大。本研究旨在客观评估我们科室实施的所有神经外科手术的发病率和死亡率，并深入了解其主要原因，确定降低发病率的关键因素。
从 2016 年 11 月至 2016 年 4 月在 APHM-马赛提蒙大学医院神经外科接受颅脑或脊柱神经外科手术的患者前瞻性维护的数据库中检索数据。未包括接受功能、儿科或介入神经放射学手术的患者。
共分析了 963 名患者的病历。208 名患者（21.6%）出现术后并发症，其中颅脑手术组 115 例（26.6%），脊柱手术组 93 例（17.5%）。颅脑手术组并发症发生率比脊柱手术组高 1.5 倍。颅脑手术发生并发症的风险是脊柱手术的 1.5 倍（P=0.007）。术前合并症（ASA 评分>3 至 4）与并发症的发生显著相关（P<0.001）。在颅脑组，急症手术发生并发症的风险是择期手术的 1.8 倍（P<0.001）。相反，在脊柱组，择期手术发生并发症的风险比急症手术低 1.4 倍（P=0.04）。两组的主要并发症均为术后感染，发生率分别为颅脑和脊柱手术的 9.3%和 11.1%。术后死亡率分别为 4.9%和 1.7%，平均住院时间分别为 12 天和 11 天。
我们的研究结果显示，并发症的发生率相对较高，主要原因是术后感染。加强每个环节的良好实践措施，应有助于显著降低我们的并发症发生率。
