Schipmann Stephanie, Sletvold Truls P, Wollertsen Yvonne, Schwake Michael, Raknes Ingrid Cecilie, Miletić Hrvoje, Mahesparan Rupavathana
Department of Neurosurgery, Haukeland University Hospital, Jonas Lies veg 65, 5021, Bergen, Norway.
Department of Neurorsugery, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
Brain Spine. 2023 Apr 29;3:101739. doi: 10.1016/j.bas.2023.101739. eCollection 2023.
Atypical meningiomas represent approximately 20% of all intracranial meningiomas and are characterized by distinct histopathological criteria and an increased risk of postoperative recurrence. Recently, quality indicators have been introduced to monitor quality of the delivered care.
Which quality indicators/outcome measures are being applied in patients being operated for atypical meningiomas? What are risk factors associated with poor outcome? How is the surgical outcome and which quality indicators are reported in the literature?
The primary outcomes of interest were 30-days readmission-, 30-day reoperation-, 30-day mortality-, 30-day nosocomial infection- and the 30-day surgical site infection (SSI) rate, CSF-leakage, new neurological deficit, medical complications, and lengths of stay. The secondary aim was the identification of prognostic factors for the mentioned primary outcomes. A systematic review of the literature was performed screening studies for the mentioned outcomes.
We included 52 patients. 30-days outcomes in terms of unplanned reoperation were 0%, unplanned readmission 7.7%, mortality 0%, nosocomial infection 17.3%, and SSI 0%. Any adverse event occurred in 30.8%. Preoperative C-reactive protein over 5 mg/l was independent factor for the occurrence of any postoperative adverse event (OR: 17.2, p = 0.003). A total of 22 studies were included into the review.
The 30-days outcomes at our department were comparable with reported outcomes in the literature. Currently applied quality indicators are helpful in determining the postoperative outcome but mainly report the indirect outcome after surgery and are influenced of patient, tumor and treatment related factors. Risk adjustment is vital.
非典型脑膜瘤约占所有颅内脑膜瘤的20%，其特征在于独特的组织病理学标准以及术后复发风险增加。最近，已引入质量指标来监测所提供护理的质量。
在接受非典型脑膜瘤手术的患者中应用了哪些质量指标/结果测量方法？与不良结果相关的风险因素有哪些？手术结果如何，文献中报告了哪些质量指标？
主要关注的结果是30天再入院率、30天再次手术率、30天死亡率、30天医院感染率和30天手术部位感染（SSI）率、脑脊液漏、新的神经功能缺损、医疗并发症以及住院时间。次要目标是确定上述主要结果的预后因素。对文献进行了系统回顾，筛选了提及上述结果的研究。
我们纳入了52例患者。计划外再次手术方面的30天结果为0%，计划外再入院率为7.7%，死亡率为0%，医院感染率为17.3%，SSI率为0%。30.8%的患者发生了任何不良事件。术前C反应蛋白超过5mg/l是发生任何术后不良事件的独立因素（比值比：17.2，p = 0.003）。该综述共纳入22项研究。
我们科室的30天结果与文献中报告的结果相当。目前应用的质量指标有助于确定术后结果，但主要报告手术的间接结果，并且受患者、肿瘤和治疗相关因素的影响。风险调整至关重要。
