Format

Send to

Choose Destination
Clin Neurol Neurosurg. 2018 Aug;171:109-115. doi: 10.1016/j.clineuro.2018.06.015. Epub 2018 Jun 10.

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

Author information

1
School of Medicine, University of California, San Diego, San Diego, CA, USA.
2
Division of Otolaryngology - Head and Neck Surgery, University of California, San Diego, San Diego, CA, USA.
3
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School/Brigham & Women's Hospital, Boston, MA, USA.
4
Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
5
Department of Anesthesiology, University of California, San Diego, San Diego, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA. Electronic address: ragabriel@ucsd.edu.

Abstract

OBJECTIVES:

Updated multi-institutional database studies assessing perioperative risk factors on 30-day morbidity and mortality after skull base surgeries are limited. We aim to identify perioperative risk factors and report the incidence of 30-day morbidity and mortality in adult patients after skull base surgery.

PATIENTS AND METHODS:

We queried the 2007-2016 American College of Surgeons National Surgical Quality Improvement program database to identify patients who underwent anterior, middle, or posterior skull base surgery. We performed multivariable logistic regression to identify risk factors associated with 30-day morbidity and mortality. Postoperative events were compared between propensity score matched cohorts (no morbidity versus 30-day morbidity).

RESULTS:

The final analysis included 1028 adult (≥18 years old) patients. The incidence of 30-morbidity and mortality was 14.6% and 1.6%, respectively. Postoperative ventilator dependence (52.9%) followed by pneumonia (23.5%) and unplanned intubation (23.5%) had the highest prevalence among those with 30-day mortality. The adjusted odds of 30-day morbidity was significantly higher among patients with functional dependency, American Society of Anesthesiologists Physical Status ≥4, hyponatremia, and anemia (p < 0.05). The adjusted odds of 30-day mortality was significantly increased among patients with sepsis, bleeding disorder, disseminated cancer, and older age (p < 0.05).

CONCLUSION:

Clinical perioperative factors are significantly associated with 30-day morbidity and mortality after skull base surgery. The reported rate of 30-day morbidity and mortality was similar to earlier studies and therefore highlights the need for continued quality improvement.

KEYWORDS:

Morbidity; Mortality; Neurotologic surgery; Perioperative risk factors; Postoperative adverse events; Skull base surgery

PMID:
29906680
DOI:
10.1016/j.clineuro.2018.06.015
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center