Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients.

Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS.  Patient data from 2015 to 2020 were obtained from the American College of Surgeons-National Surgical Quality Improvement Program database and were included in this study if they had a procedure corresponding to an MVD with the current procedural terminology code 61458. Patient demographics, comorbidities, and outcomes were analyzed. Patients were subsequently categorized based on body mass index (BMI) and a logistic regression analysis was used to model the association of comorbidities with reoperation and its indication.  The overall rate of reoperation in the cohort is 3.2 and 7.2% for patients with morbid obesity (BMI ≥ 40;  = 0.006). Patients with morbid obesity were more likely to present at a younger age (50.1 vs. 57.4;  < 0.0001), have comorbidities such as hypertension (60.9 vs. 33.5%;  < 0.0001) and diabetes (16.3 vs. 7.7%;  = 0.0002), and increased procedure duration (179 vs. 164 minutes;  = 0.02). Indications for reoperation include cerebrospinal fluid (CSF) leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation.  We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reoperation.