Department of Neuroanaesthesia and Neurocritical Care, National Hospital for Neurology and Neurosurgery.
UCL Queen Square Institute of Neurology, London, UK.
J Neurosurg Anesthesiol. 2022 Apr 1;34(2):201-208. doi: 10.1097/ANA.0000000000000756.
The incidence of morbidity after cranial neurosurgery is significant, reported in up to a quarter of patients depending on methodology used. The Postoperative Morbidity Survey (POMS) is a reliable method for identifying clinically relevant postsurgical morbidity using 9 organ system domains. The primary aim of this study was to quantify early morbidity after cranial neurosurgery using POMS. The secondary aims were to identify non-POMS-defined morbidity and association of POMS with postoperative hospital length of stay (LOS).
A retrospective electronic health care record review was conducted for all patients who underwent elective or expedited major cranial surgery over a 3-month period. Postsurgical morbidity was quantified on postoperative days (D) 1, 3, 5, 8, and 15 using POMS. A Poisson regression model was used to test the correlation between LOS and total POMS scores on D1, 3 and 5. A further regression model was used to test the association of LOS with specific POMS domains.
A total of 246 patients were included. POMS-defined morbidity was 40%, 30%, and 33% on D1, D3, and D8, respectively. The presence of POMS morbidity on these days was associated with longer median (range) LOS: D1 6 (1 to 49) versus 4 (2 to 45) days; D3 8 (4 to 89) versus 6 (4 to 35) days; D5 14 (5 to 49) versus 8.5 (6 to 32) days; D8 18 (9 to 49) versus 12.5 (9 to 32) days (P<0.05). Total POMS score correlated with overall LOS on D1 (P<0.001), D3 (P<0.001), and D5 (P<0.001). A positive response to the "infectious" (D1, 3), "pulmonary" (D1), and "renal" POMS items (D1) were associated with longer LOS.
Although our data suggests that POMS is a useful tool for measuring morbidity after cranial neurosurgery, some important morbidity items that impact on LOS are missed. A neurosurgery specific tool would be of value.
颅脑神经外科术后发病率较高，根据所采用的方法，高达四分之一的患者会出现这种情况。术后发病率调查（POMS）是一种使用 9 个器官系统领域来识别临床相关术后发病率的可靠方法。本研究的主要目的是使用 POMS 量化颅脑神经外科术后早期发病率。次要目的是确定非 POMS 定义的发病率以及 POMS 与术后住院时间（LOS）的相关性。
对 3 个月内接受择期或紧急大颅手术的所有患者进行回顾性电子医疗记录审查。术后第 1、3、5、8 和 15 天使用 POMS 量化术后发病率。使用泊松回归模型检验 LOS 与第 1、3 和 5 天总 POMS 评分之间的相关性。进一步的回归模型用于检验 LOS 与特定 POMS 领域的相关性。
共纳入 246 例患者。第 1、3 和 8 天的 POMS 定义发病率分别为 40%、30%和 33%。这些天出现 POMS 发病率与更长的中位（范围）LOS 相关：第 1 天 6（1 至 49）天与 4（2 至 45）天；第 3 天 8（4 至 89）天与 6（4 至 35）天；第 5 天 14（5 至 49）天与 8.5（6 至 32）天；第 8 天 18（9 至 49）天与 12.5（9 至 32）天（P<0.05）。总 POMS 评分与第 1、3 和 5 天的总体 LOS 相关（P<0.001）。对“感染”（第 1、3 天）、“肺部”（第 1 天）和“肾脏”（第 1 天）POMS 项目的阳性反应与 LOS 延长相关。
尽管我们的数据表明 POMS 是测量颅脑神经外科术后发病率的有用工具，但一些影响 LOS 的重要发病率项目却被遗漏了。一种专门针对神经外科的工具将具有价值。
