Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
World Neurosurg. 2022 Jul;163:e290-e300. doi: 10.1016/j.wneu.2022.03.113. Epub 2022 Apr 1.
Nontraumatic subarachnoid hemorrhage (SAH) refers to high pressure extravasation of blood into the subarachnoid space that typically occurs spontaneously from rupture of cerebral aneurysm. The purpose of this study was to identify postoperative complications requiring increased surveillance in obese, diabetic, and hypertensive patients.
Patients who underwent surgical treatment for nontraumatic SAH were queried in the American College of Surgeons National Surgical Quality Improvement Program database from the years 2012-2018. Cases were identified using International Classification of Diseases codes and then classified independently by 3 dichotomous diagnoses: obesity, diabetes, and hypertension.
Among 1002 patients meeting inclusion criteria, 311 (31%) were obese (body mass index >30), 86 (9%) had diabetes treated with insulin or noninsulin agents, and 409 (41%) required medication for hypertension. There was a statistically significant association between diabetes and postoperative pneumonia (odds ratio [OR] = 1.694; 95% confidence interval [CI] = 0.995-2.883; P = 0.050), prolonged ventilator dependence (OR = 1.700; 95% CI = 1.087-2.661; P = 0.019), and death (OR = 1.846; 95% CI = 1.071-3.179; P = 0.025). Medication-dependent hypertension was statistically associated with incidence of stroke/cerebrovascular accident (OR = 1.763; 95% CI = 1.056-2.943; P = 0.023). Obesity was not associated with adverse outcomes in this population.
In patients undergoing surgical management of SAH, hypertensive and diabetic patients had poorer outcomes, including prolonged ventilator dependence, pneumonia, stroke/cerebrovascular accident, and death. Surprisingly, preexisting obesity was not associated with poor outcomes. In fact, overweight body mass index, class I obesity, and class II obesity had decreased need for transfusion in the 30-day postoperative period.
非创伤性蛛网膜下腔出血（SAH）是指血液从脑动脉瘤破裂后，通常自发性地高压外渗到蛛网膜下腔。本研究的目的是确定需要增加监测的肥胖、糖尿病和高血压患者的术后并发症。
从 2012 年至 2018 年，在美国外科医师学会国家手术质量改进计划数据库中查询接受非创伤性 SAH 手术治疗的患者。使用国际疾病分类代码识别病例，然后由 3 个二分类诊断独立分类：肥胖、糖尿病和高血压。
在符合纳入标准的 1002 名患者中，311 名（31%）为肥胖（体重指数>30），86 名（9%）患有胰岛素或非胰岛素治疗的糖尿病，409 名（41%）需要药物治疗高血压。糖尿病与术后肺炎（比值比[OR] = 1.694；95%置信区间[CI] = 0.995-2.883；P = 0.050）、呼吸机依赖延长（OR = 1.700；95%CI = 1.087-2.661；P = 0.019）和死亡（OR = 1.846；95%CI = 1.071-3.179；P = 0.025）之间存在统计学显著关联。药物依赖型高血压与中风/脑血管意外（OR = 1.763；95%CI = 1.056-2.943；P = 0.023）的发生率存在统计学关联。在该人群中，肥胖与不良结局无关。
在接受 SAH 手术治疗的患者中，高血压和糖尿病患者的预后较差，包括呼吸机依赖延长、肺炎、中风/脑血管意外和死亡。令人惊讶的是，先前存在的肥胖与不良结局无关。事实上，超重的体重指数、I 类肥胖和 II 类肥胖在术后 30 天内需要输血的可能性降低。
