Diabetes and morbid obesity are associated with higher reoperation rates following microvascular decompression surgery: An ACS-NSQIP analysis

Abstract

Background:Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. Despite its high rate of success, MVD carries risk of complications. In this study, we examine outcomes following MVD and identify risk factors associated with adverse outcomes.Methods:A review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was performed with CPT code 61458 queried between 2007 and 2014. Demographics, preoperative comorbidities, and 30-day outcomes were analyzed. Univariate and multivariate regression analyses were performed to identify predictors of reoperation and adverse events.Results:Five hundred and six craniotomies were studied. Nineteen (5.5%) instances of 30-day readmission were reported, with 14 (2.8%) patients returning to the operating room. No instances of death or hemorrhage requiring operation were reported. Morbid obesity (body mass index >40) (P = 0.030) and diabetes (P = 0.017) were associated with risk of reoperation. Age, operative time, and indication for surgery were not associated with significant differences in adverse events.Conclusions:MVD is a common and effective procedure with a relatively safe profile and low 30-day risk of reoperation. Advanced age is not associated with worse outcomes. Obesity and diabetes, however, are associated with increased risk of reoperation and may warrant additional precautions.

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

“…Reoperation after an MVD has been reported as high as 11% 10 and typically occurs due to CSF leak, surgical site infection, or recurrent/persistent pain or spasm. 17 The reoperation rate is unacceptably high for a surgery with reasonable alternative treatment options. Moreover, postoperative complications following repeat surgery has been reported at 37% and includes facial numbness, hearing loss, infection, and CSF leak.…”

“…6,13,17,19 Risk factors for reoperation have been linked to obesity and diabetes, but in series with small sample sizes. 17 Given the relatively high and unacceptable rate of reoperation for an elective procedure with reasonable treatment alternatives, we sought to further elucidate and characterize these risk factors for reoperation for MVD with the goal of potentially identifying a patient population that may benefit from further optimization prior to surgery and/or alternative initial treatment options. We hypothesized that morbidly obese (BMI > 40) patients are at greater risk for reoperation following MVD.…”

Surgical Outcome of Microvascular Decompression for Hemifacial Spasm: Symptom Control and Quality of Life

“…According to Liu et al (27), the disease affects patients between the fourth and fifth decades of life and usually presents a mean duration of six years in all operated patients. Additionally, it is also believed that some individuals present risk factors for higher rates of surgical failure or recurrence due to stronger compression of the nerve, such as arterial hypertension, diabetes, and morbid obesity (30,31). In the present study, most patients were female, were in the fifth decade of life and presented more frequently right sided symptoms with mean duration of 6.8 years before surgery.…”

Case Series in the Utility of Invasive Blood Pressure Monitoring in Microvascular Decompression

“…Although overall risks are low, local catheter site infection, hemorrhage, hematoma, sepsis, permanent ischemic damage, pseudoaneurysm formation, and arteriovenous fistulas have been documented as potential complications of invasive blood pressure monitoring. [11][12][13][14][15][16] Over the past 10 years at our institution, a concerted effort was made by the department of neurosurgery and the department of anesthesiology to improve patient safety and neurosurgical intraoperative and postoperative resource utilization, and the necessity of arterial line placement in MVDs was assessed.…”