Complications Predicting Perioperative Mortality in Patients Undergoing Elective Craniotomy: A Population-Based Study

Area of Science:

• Neurosurgery
• Surgical Outcomes Research
• Critical Care Medicine

Background:

• Elective craniotomy is a complex procedure with potential for significant morbidity and mortality.
• Identifying specific complications that independently drive mortality is crucial for targeted interventions.
• Previous studies often did not fully isolate the effect of individual complications from preoperative risk factors or other concurrent complications.

Purpose of the Study:

• To determine the independent impact of various postoperative complications on 30-day mortality following elective craniotomy.
• To analyze these effects across different patient risk strata.
• To inform strategies for reducing perioperative mortality in neurosurgical patients.

Main Methods:

• Utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2006-2015).
• Included 32,695 patients who underwent elective craniotomy.
• Employed multivariate logistic regression to assess the independent effect of 13 complications on 30-day mortality, controlling for preoperative risk and other complications, and analyzed findings in risk-stratified subgroups.

Main Results:

• Unplanned intubation (OR 12.1), stroke (OR 11.1), prolonged ventilator requirement >48 hours (OR 9.9), and renal failure (OR 8.5) were strongly associated with increased 30-day mortality, independent of preoperative risk.
• These complications also independently predicted mortality when other postoperative complications were considered.
• Complications like venous thromboembolism, urinary tract infection, unplanned reoperation, and surgical site infection did not show a significant independent association with increased mortality.

Conclusions:

• Myocardial infarction, unplanned intubation, prolonged ventilator requirement, stroke, and renal failure are key drivers of perioperative mortality after elective craniotomy.
• These findings highlight specific complications that warrant focused preventive and management strategies.
• Reducing failure-to-rescue rates in neurosurgery necessitates dedicated resources to mitigate these identified high-risk complications.