An updated assessment of morbidity and mortality following skull base surgical approaches

Burton, Brittany N.; Hu, Jenny Qin; Jafari, Aria; Urman, Richard D.; Dunn, Ian F.; Bi, Wenya Linda; DeConde, Adam S.; Gabriel, Rodney A.

doi:10.1016/j.clineuro.2018.06.015

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…[28][29][30][32][33][34] Numerous investigations of anemia, bleeding prophylaxis, and transfusion requirements in surgeries of the head and neck suggest that implementation of robust PBM programs would be highly beneficial in these surgeries. 23,24,35,36 Our findings suggest that clinicians performing VSB surgery should be aware of preoperative anemia in their patients due to the increased risk of complications. Existing literature on PBM may help mitigate postoperative complications.…”

Section: Discussionmentioning

confidence: 76%

“…Despite a robust body of evidence supporting the effectiveness of PBM in improving patient outcomes and decreasing costs in a variety of surgeries, there is a lack of research investigating its efficacy in surgery of the head and neck 28–30,32–34 . Numerous investigations of anemia, bleeding prophylaxis, and transfusion requirements in surgeries of the head and neck suggest that implementation of robust PBM programs would be highly beneficial in these surgeries 23,24,35,36 . Our findings suggest that clinicians performing VSB surgery should be aware of preoperative anemia in their patients due to the increased risk of complications.…”

Section: Discussionmentioning

confidence: 83%

“…Although the association did not remain significant in a multivariate analysis, similar findings have been reported in a number of studies, including those focusing specifically on surgeries of the head and neck. [9][10][11]13,23,24 Further investigation examining the independent effect of anemia on mortality in VSB surgery is warranted.…”

Section: Discussionmentioning

confidence: 99%

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Complication Risk in Ventral Skull Base Surgery Based on Preoperative Hematocrit

et al. 2021

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Objectives/Hypothesis Preoperative anemia has been shown to be a predictor of complications in different surgeries. This has not been exclusively studied in skull base surgery. This study investigates the impact of preoperative hematocrit on complications following ventral skull base (VSB) surgery. Study Design Retrospective database review. Methods The National Surgical Quality Improvement Program was queried for all cases of VSB surgery from 2005 to 2015. Univariate and multivariate analyses were performed to investigate the impact of preoperative anemia on complications following VSB procedures. Results 3,053 patients meeting inclusion criteria were identified. On univariate analysis, low hematocrit was found in 39.7% of patients and was associated with increased mean age (55.71 vs. 53.25 years), male gender (63.6% vs. 36.4%), and Black race (18.5% vs. 10.9%). Preoperative anemia was also associated with increased incidences of postoperative pneumonia, blood transfusions, sepsis, medical complications, surgical complications, extended length of hospital stay (LOS), and mortality. On multivariate analysis, associations between low preoperative hematocrit and perioperative transfusions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.88–3.50, P < .001), total surgical complications (OR 2.12, 95% CI 1.60–2.80, P < .001), and extended LOS (OR 1.29, 95% CI 1.05–1.57, P = .013) remained significant. Conclusions Low preoperative hematocrit is associated with increased risk of postoperative complications and extended LOS in patients undergoing VSB surgery. This study highlights the importance of careful preoperative assessment and management of anemia in these patients. Level of Evidence 3 Laryngoscope, 132:1707–1713, 2022

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 83%

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Complication Risk in Ventral Skull Base Surgery Based on Preoperative Hematocrit

et al. 2021

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“…In addition to this approximately 5% of head and neck paragangliomas will secrete catecholamines leading to tachycardia, hypertension and profuse sweating [10]. However, also owing to the anatomical complexity of the lateral skull base, treatment of disease in this area poses significant challenges with notable treatment associated morbidity including cranial neuropathies and major vascular injury [11,12]. Given that paragangliomas are benign and often slow growing, it is critical to balance the morbidity of the disease against the morbidity of any proposed treatment.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Multidisciplinary Management of Lateral Skull Base Paragangliomas: A 20-Year Experience

Cleere,

Mc Loughlin,

McArdle

et al. 2023

J Neurol Surg B Skull Base

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Objectives Paragangliomas of the lateral skull base are rare, largely benign, neuroendocrine tumors. Little evidence exists to support clinicians in the management of these tumors. The present study evaluates considerations in the multidisciplinary workup and management of paragangliomas affecting the lateral skull base. Methods A STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist compliant retrospective review of adult patients with lateral skull base paragangliomas over 20 years (2002–2021) was performed. Patient and tumor data were collected from patient health care records. Results Seventy patients were identified including 21 (30.0%) males and 49 (70.0%) females. The mean length of follow-up was 87.3 months (range: 12–239 months). Twenty-nine (41.4%) patients had Fisch A or B tumors. Overall, 57 patients (81.4%) were offered treatment upfront, with 13 patients (18.6%) initially undergoing active surveillance. Younger age and reduced American Society of Anesthesiologists (ASA) grade was significantly associated with a decision to offer treatment at presentation (both p = 0.03), while all patients with succinate dehydrogenase (SDH) mutations (n = 10) and tumor secretion (n = 4) were offered treatment. Patients with Fisch A/B tumors (p = 0.01), cranial neuropathies (p = 0.01), and smaller tumors (p = 0.01) were more likely to undergo surgical resection. At the time of the last follow-up, the proportion of patients with a cranial neuropathy was notably lower in the observation (3/12, 25.0%) and radiotherapy (1/6, 16.7%) groups. Conclusions In our series, younger, fitter patients with SDH mutations, cranial neuropathies, or tumor secretion were more likely to be offered upfront treatment. There was a low incidence of new cranial neuropathy in the patients selected for observation during long-term follow-up.

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“…6 Despite development of technologies such as endoscopy and vascularized repairs, ACF tumor resection remains difficult and may carry higher morbidity than operations of the middle or posterior skull base. 7 ABBREVIATIONS: ACF, anterior cranial fossa; ACS-NSQIP, American College of Surgeons National Surgical Quality Improvement Program; API, Asian and Pacific Islander; CHF, congestive heart failure; CPT, Current Procedural Terminology; eLOS, extended length of stay; LOS, length of stay; PA, pituitary adenoma; RVUs, relative value units; SIRS, systemic inflammatory response syndrome; SSI, surgical site infection; TIA, transient ischemic attack. Supplemental digital content is available for this article at neurosurgery-online.com.…”

mentioning

confidence: 99%

Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study

et al. 2023

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BACKGROUND: Race-based health care outcomes remain to be described in anterior cranial fossa (ACF) surgery. OBJECTIVE: To determine whether race predicts worse outcomes after ACF surgery. METHODS: A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program data for 2005 to 2020. Current Procedural Terminology and International Classification of Diseases-9 codes were used to identify ACF tumor cases. Propensity score matching was performed to compare White and minority patients to assess the robustness of unmatched findings. A subanalysis of pituitary adenoma (PA) resections was also performed. RESULTS: In an unmatched analysis of 1370 patients who underwent ACF surgery (67.9% White, 17.4% Black, 6.6% Asian/ Pacific Islander, and 6.3% Hispanic), minority groups had higher rates of comorbidities. Unmatched multivariate analysis found Hispanic patients bore a 1.86 odds ratio (OR) of minor complications, Black and Asian and Pacific Islander patients bore 1.49 and 1.71 ORs, respectively, for extended length of stay, and Black patients bore a 3.78 OR for urinary tract infection (UTI). Matched analysis found that minority patients had higher UTI rates (P = .02) and a 4.11 OR of UTI. In PA cases specifically, minority groups had higher comorbidities and length of stay in addition to extended length of stay odds (1.84 OR). CONCLUSION: Although most ACF surgery outcomes were unaffected by race, minority groups had more minor postoperative complications than White patients, particularly UTI. Similar disparities were observed among PA cases. Higher rates of comorbidities may also have led to longer hospital stays. Further study is needed to understand what actions might be necessary to address any race-associated health disparities in ACF surgery.

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An updated assessment of morbidity and mortality following skull base surgical approaches

Cited by 9 publications

References 28 publications

Complication Risk in Ventral Skull Base Surgery Based on Preoperative Hematocrit

Complication Risk in Ventral Skull Base Surgery Based on Preoperative Hematocrit

Multidisciplinary Management of Lateral Skull Base Paragangliomas: A 20-Year Experience

Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study

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