Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
World Neurosurg. 2022 Oct;166:e358-e368. doi: 10.1016/j.wneu.2022.07.006. Epub 2022 Jul 8.
Research on the effects of substance use disorders (SUDs) on postoperative outcomes within neurosurgical oncology has been limited. Therefore, the present study sought to quantify the effect of having a SUD on hospital length of stay, postoperative complication incidence, discharge disposition, hospital charges, 90-day readmission rates, and 90-day mortality rates following brain tumor surgery.
The present study used data from patients who received surgical resection for brain tumor at a single institution between January 1, 2017, and December 31, 2019. The Mann-Whitney U test was used for bivariate analysis of continuous variables and Fisher exact test was used for bivariate analysis of categorical variables. Multivariate analysis was conducted using logistic regression models.
Our study cohort included a total of 2519 patients, 124 (4.9%) of whom had at least 1 SUD. More specifically, 90 (3.6%) patients had an alcohol use disorder, 27 (1.1%) had a cannabis use disorder, and 12 (0.5%) had an opioid use disorder. On bivariate analysis, 90-day hospital readmission was the only postoperative outcome significantly associated with a SUD (odds ratio 2.21, P = 0.0011). When controlling for patient age, sex, race, marital status, insurance, brain tumor diagnosis, 5-factor modified frailty index score, American Society of Anesthesiologists score, and surgery number, SUDs remained significantly and independently associated with 90-day readmission (odds ratio 1.82, P = 0.013).
In patients with brain tumor, SUDs significantly and independently predict 90-day hospital readmission after surgery. Targeted management of patients with SUDs before and after surgery can optimize patient outcomes and improve the provision of high-value neurosurgical care.
关于物质使用障碍（SUDs）对神经外科肿瘤学术后结果的影响的研究有限。因此，本研究旨在量化 SUD 对脑肿瘤手术后住院时间、术后并发症发生率、出院去向、住院费用、90 天再入院率和 90 天死亡率的影响。
本研究使用了 2017 年 1 月 1 日至 2019 年 12 月 31 日期间在一家机构接受脑肿瘤手术切除的患者的数据。采用 Mann-Whitney U 检验进行连续变量的双变量分析，采用 Fisher 确切检验进行分类变量的双变量分析。采用 logistic 回归模型进行多变量分析。
本研究队列共纳入 2519 例患者，其中 124 例（4.9%）至少有 1 种 SUD。具体而言，90 例（3.6%）患者患有酒精使用障碍，27 例（1.1%）患者患有大麻使用障碍，12 例（0.5%）患者患有阿片类药物使用障碍。在单变量分析中，90 天的医院再入院是唯一与 SUD 显著相关的术后结果（优势比 2.21，P=0.0011）。在校正患者年龄、性别、种族、婚姻状况、保险、脑肿瘤诊断、5 项修正虚弱指数评分、美国麻醉医师协会评分和手术次数后，SUD 仍与 90 天再入院显著独立相关（优势比 1.82，P=0.013）。
在脑肿瘤患者中，SUD 显著且独立地预测术后 90 天的医院再入院。在手术前后对 SUD 患者进行有针对性的管理，可以优化患者的预后，并提高高质量神经外科护理的提供。
