Rienas William, Li Renxi, Lee SeungEun, Ryan Lianne, Rienas Christopher
Department of Clinical and Translational Research, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Department of Clinical and Translational Science, University of Massachusetts T.H. Chan School of Medicine, Worcester, United States.
Surg Neurol Int. 2024 Sep 13;15:333. doi: 10.25259/SNI_569_2024. eCollection 2024.
Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency, and functional status is often a predictor of adverse outcomes perioperatively. Patients with different functional statuses may have different perioperative outcomes during surgery for aSAH. This study retrospectively examines the effect of functional status on specific perioperative outcomes in patients receiving craniotomy for aSAH.
Patients with aSAH who underwent neurosurgery were identified using International Classification of Diseases (ICD) codes (ICD10, I60; ICD9, 430) in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2021. Subjects were stratified into two study groups: functionally dependent and functionally independent, based on their documented functional status on NSQIP. Significant preoperative differences were present between groups so a multivariable regression was performed between functionally dependent and independent patients. The 30-day perioperative outcomes of the two groups were compared. Perioperative outcomes included death, major adverse cardiovascular events (MACEs), cardiac complications, stroke, wound complications, renal complications, sepsis, clot formation, pulmonary complications, return to the operating room, operation time >4 h, length of stay longer than 7 days, discharge not to home, and bleeding.
For aSAH patients receiving craniotomy repair, functionally dependent patients had significantly greater rates of MACE, cardiac complications, sepsis, pulmonary complications, and discharge not to home compared to functionally independent patients.
This study shows specific perioperative variables influenced by dependent functional status when treating aSAH through craniotomy, thus leading to a more complicated postoperative course. Additional research is needed to confirm these findings among the specific variables that we analyzed.
动脉瘤性蛛网膜下腔出血（aSAH）是一种医疗急症，功能状态通常是围手术期不良结局的预测指标。在aSAH手术期间，具有不同功能状态的患者可能有不同的围手术期结局。本研究回顾性分析了功能状态对接受aSAH开颅手术患者特定围手术期结局的影响。
利用美国外科医师学会国家外科质量改进计划（NSQIP）数据库中2005年至2021年的国际疾病分类（ICD）编码（ICD10，I60；ICD9，430）识别接受神经外科手术的aSAH患者。根据NSQIP记录的功能状态，将受试者分为两个研究组：功能依赖组和功能独立组。两组术前存在显著差异，因此对功能依赖和独立的患者进行了多变量回归分析。比较两组的30天围手术期结局。围手术期结局包括死亡、主要不良心血管事件（MACE）、心脏并发症、中风、伤口并发症、肾脏并发症、败血症、血栓形成、肺部并发症、返回手术室、手术时间>4小时、住院时间超过7天、出院未回家以及出血。
对于接受开颅修复的aSAH患者，与功能独立的患者相比，功能依赖的患者发生MACE、心脏并发症、败血症、肺部并发症以及出院未回家的发生率显著更高。
本研究表明，在通过开颅手术治疗aSAH时，特定的围手术期变量受功能依赖状态的影响，从而导致术后病程更加复杂。需要进一步的研究来在我们分析的特定变量中证实这些发现。
