Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011

Abstract

Object Surgical complications increase the cost of health care worldwide and directly contribute to patient morbidity and mortality. In an effort to mitigate morbidity and incentivize best practices, stakeholders such as health insurers and the US government are linking reimbursement to patient outcomes. In this study the authors analyzed a national database to determine basic metrics of how comorbidities specifically affect the subspecialty of neurosurgery. Methods Data on 1,777,035 patients for the years 2006–2011 were acquired from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as “neurological surgery.” Univariate statistics were calculated using the chi-square test, and 95% confidence intervals were determined for the resultant risk ratios. A multivariate model was constructed using significant variables from the univariate analysis (p < 0.05) with binary logistic regression. Results Over 38,000 neurosurgical cases were analyzed, with complications occurring in 14.3%. Cranial cases were 2.6 times more likely to have complications than spine cases, and African Americans and Asians/Pacific Islanders were also at higher risk. The most frequent complications were bleeding requiring transfusion (4.5% of patients) and reoperation within 30 days of the initial operation (4.3% of patients), followed by failure to wean from mechanical ventilation postoperatively (2.5%). Significant predictors of complications included preoperative stroke, sepsis, blood transfusion, and chronic steroid use. Conclusions Understanding the landscape of neurosurgical complications will allow better targeting of the most costly and harmful complications of preventive measures. Data from the ACS NSQIP database provide a starting point for developing paradigms of improved care of neurosurgical patients.

Preoperative identification of neurosurgery patients with a high risk of in-hospital complications: a prospective cohort of 418 consecutive elective craniotomy patients

“…As another possible drawback, patients' comorbidities were not included as possible contributors to outcome, similar to the previous registry-based study. 10 The main reason for excluding such data in the analyses was to increase the external validity of the results. In addition to highly varying incidences and prevalence, comorbidities, such as hypertension, myocardial disease, and renal insufficiency, are diagnosed and treated differently in different countries and institutions, and thus inclusion of these data would probably decrease the generalizability of the results.…”

“…When identifying new associations with surgical outcomes, most large registries and databases cannot provide us with detailed and useful results. In the recent retrospective study of more than 10,000 cranial neurosurgery patients, 10 the incomplete reflection of patient characteristics obtained from the database as well as the lack of fit for the complications unique to neurosurgical patients hindered the identification of useful predictors for adverse outcome, as discussed by the authors. Furthermore, the reliability of evaluating the quality of care based on such registries is compromised by the rarity of outcome events along with the low caseload in many individual hospitals.…”

“…10 This retrospective study could not assess the role of routine preoperative blood tests, ASA class, or any other preoperative risk score in outcome prediction. Furthermore, the reliability of predicting outcomes by using registry-based data has been questioned by others 5 and even by the authors themselves, 10 specifically since in many large registries detailed preoperative patient data are lacking. Another major problem is that the type and rate of complications in neurosurgery are variable but limited.…”

Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

“…Based on a previous NSQIP study of neurosurgical complications, 17 univariate analyses were performed on variables that were either demonstrated to be or, based on our background knowledge and medical reasoning, reasonably could be predictors of adverse outcomes in the neurosurgical population. These variables included demographic and preoperative factors such as age, sex, race, spinal versus cranial case, inpatient versus outpatient status, emergency versus nonemergency status of the case, preoperative transfusion with > 4 units of packed red blood cells, and preoperative sepsis.…”

Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale

“…18,39 The issue of how to define the negative results of surgical procedures were initially a matter of debate in the field of general surgery and recently in the neurosurgical community. 17,18,23,31,35 More than 20 years ago, general surgeons defined a complication as any morbid event occurring "as a result of the procedure, during the performance or recovery from the procedure, which causes deviations from the ideal course and tends to impair or delay complete recovery and induces changes in the management of the patient." 10 The same authors brought up another pivotal concept: the complexity of surgery, which arises from the preoperative conditions and is defined as the risk to incur in postoperative complications and negative outcomes.…”