Adverse events in neurosurgery: a comprehensive single-center analysis of a prospectively compiled database

Abstract

Purpose To prospectively identify and quantify neurosurgical adverse events (AEs) in a tertiary care hospital. Methods From January 2021 to December 2021, all patients treated in our department received a peer-reviewed AE-evaluation form at discharge. An AE was defined as any event after surgery that resulted in an undesirable clinical outcome, which is not caused by the underlying disease, that prolonged patient stay, resulted in readmission, caused a new neurological deficit, required revision surgery or life-saving intervention, or contributed to death. We considered AEs occurring within 30 days after discharge. AEs were categorized in wound event, cerebrospinal fluid (CSF) event, CSF shunt malfunction, post-operative infection, malpositioning of implanted material, new neurological deficit, rebleeding, and surgical goal not achieved and non-neurosurgical AEs. Results 2874 patients were included. Most procedures were cranial (45.1%), followed by spinal (33.9%), subdural (7.7%), CSF (7.0%), neuromodulation (4.0%), and other (2.3%). In total, there were 621 AEs shared by 532 patients (18.5%). 80 (2.8%) patients had multiple AEs. Most AEs were non-neurosurgical (222; 8.1%). There were 172 (6%) revision surgeries. Patients receiving cranial interventions had the most AEs (19.1%) although revision surgery was only necessary in 3.1% of patients. Subdural interventions had the highest revision rate (12.6%). The majority of fatalities was admitted as an emergency (81/91 patients, 89%). Ten elective patients had lethal complications, six of them related to surgery (0.2%). Conclusion This study presents the one-year results of a prospectively compiled AE database. Neurosurgical AEs arose in one in five patients. Although the need for revision surgery was low, the rate of AEs highlights the importance of a systematic AE database to deliver continued high-quality in a high-volume center.

Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk–benefit analysis

“…**verified through early postoperative MRI as a nodular contrast enhancing/ FLAIR-hyperintense residual tumor (within 48 h). Data from recurrent reference and primary reference cohort available under [ 30 ]…”

“…In addition, a reference cohort of patients undergoing surgery for newly diagnosed diffuse glioma = ‘primary reference cohort’ and recurrent gliomas = ‘recurrent reference cohort’ (each as a separate group) treated at our center in 2022 was used to compare complication rates of repeat surgery with primary surgery for intracranial gliomas. This reference data is available under [ 30 ].…”

Prospective insights into spinal surgery outcomes and adverse events: A comparative study between patients 65–79 years vs. ≥80 years from a German tertiary center

“…Given our context, where the completion of POPAE forms aligns seamlessly with standard institutional procedures, there was no imperative for individual informed consents. We meticulously followed data gathering and examination methodologies, congruent with our previous disclosures ( Lenga et al, 2023a ; Dao Trong et al, 2023 ). This strategy encompassed an intricate juxtaposition of our anticipatory Post-Operative Adverse Event (POPAE) database against a broader spectrum of hospital administrative records.…”

“…This analysis encompassed patients aged 65–79 years and 80 years and older, consciously sidelining pediatric participants and those below 65 years of age. Foundational benchmarks, pivotal for this study's methodology and interpretative framework, are exhaustively expounded in our previous publications ( Lenga et al, 2023a ; Dao Trong et al, 2023 ). Such foundational integrity assures unbroken application uniformity and terminological comprehension throughout our investigative endeavors.…”

Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy

“…Unplanned early readmission (UER) in general represents a significant economic burden on health care systems [10,11] and might be used as a marker for in-hospital quality of care [12,13]. Concerning neurosurgical cohorts, several works reported an association between UER and a shortened overall survival prognosis, e.g., in glioblastoma [14][15][16].…”