Adverse Events After Microvascular Decompression: A National Surgical Quality Improvement Program Analysis
| Autor: | Hormuzdiyar H. Dasenbrock, William B. Gormley, David J. Cote, Ian F. Dunn, Timothy R. Smith |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Adolescent medicine.medical_treatment Operative Time Microvascular decompression Logistic regression Patient Readmission Article Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Trigeminal neuralgia Internal medicine Diabetes mellitus Humans Medicine Prospective Studies Registries Adverse effect Aged Aged 80 and over business.industry Incidence Incidence (epidemiology) Age Factors Length of Stay Middle Aged Neurovascular bundle medicine.disease Quality Improvement United States Microvascular Decompression Surgery Treatment Outcome 030220 oncology & carcinogenesis Female Surgery Neurology (clinical) business 030217 neurology & neurosurgery Hemifacial spasm |
| Zdroj: | World Neurosurg |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2019.05.022 |
| Popis: | Background Although microvascular decompression (MVD) is a durable treatment for medically refractory trigeminal neuralgia, hemifacial spasm, or glossopharyngeal neuralgia attributable to neurovascular conflict, few national studies have analyzed predictors of postoperative complications. Objective To determine the incidence and risk factors for adverse events after MVD. Methods Patients who underwent MVD were extracted from the prospectively collected National Surgical Quality Improvement Program registry (2006–2017). Multivariable logistic regression identified predictors of 30-day adverse events and unplanned readmission; multivariable linear regression analyzed predictors of a longer hospital stay. Results Among the 1005 patients evaluated, the mortality was 0.3%, major neurologic complication rate 0.4%, and 2.8% had a nonroutine hospital discharge. Patient age was not a predictor of any adverse events. Statistically significant independent predictors both of any adverse event (9.2%) and of a longer hospitalization were American Society of Anesthesiologists (ASA) classification III–IV designation and longer operative duration (P ≤ 0.03) The 30-day readmission rate was 6.8%, and the most common reasons were surgical site infections (22.4%) and cerebrospinal fluid leakage (14.3%). Higher ASA classification, diabetes mellitus, and operative time were predictors of readmission (P Conclusions In this National Surgical Quality Improvement Program analysis, postoperative morbidity and mortality after MVD was low. Patient age was not a predictor of postoperative complications, whereas higher ASA classification, diabetes mellitus, and longer operative duration were predictive of any adverse event and readmission. ASA classification provided superior risk stratification compared with the total number of patient comorbidities or laboratory values. These data can assist with preoperative patient counseling and risk stratification. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect