Unplanned Reoperation After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis

作者：Dasenbrock Hormuzdiyar H; Yan Sandra C; Chavakula Vamsi; Gormley William B; Smith Timothy R; Claus Elizabeth B; Dunn Ian F^*

来源：Neurosurgery, 2017, 81(5): 761-771.

DOI：10.1093/neuros/nyx089

• Brain tumor
• Craniotomy
• Intracranial hematoma
• NSQIP
• Reoperation
• Surgical site infections
• Thrombocytopenia

BACKGROUND: Reoperation has been increasingly utilized as a metric evaluating quality of care.
OBJECTIVE: To evaluate the rate of, reasons for, and predictors of unplanned reoperation after craniotomy for tumor in a nationally accrued population.
METHODS: Patients who underwent cranial tumor resection were extracted from the prospective National Surgical Quality Improvement Program registry (2012-2014). Multivariate logistic regression examined predictors of unplanned cranial reoperation. Predictors screened included patient age, sex, tumor location and histology, functional status, comorbidities, preoperative laboratory values, operative urgency, and time.
RESULTS: Of the 11 462 patients included, 3.1% (n = 350) underwent an unplanned cranial reoperation. The most common reasons for cranial reoperation were intracranial hematoma evacuation (22.5%), superficial or intracranial surgical site infections (11.9%), re-resection of tumor (8.4%), decompressive craniectomy (6.1%), and repair of cerebrospinal fluid leakage (5.6%). The strongest predictor of any cranial reoperation was preoperative thrombocytopenia (less than 100 000/mu L, odds ratio [OR] = 2.51, 95% confidence interval [CI]: 1.23-5.10, P = .01). Thrombocytopenia, hypertension, emergent surgery, and longer operative time were predictors of reoperation for hematoma (P = .004), while dependent functional status, morbid obesity, leukocytosis, and longer operative time were predictors of reoperation for infection (P < .05). Although any unplanned cranial reoperation was not associated with differential odds of mortality (OR = 1.68, 95% CI: 0.94-3.00, P = .08), hematoma evacuation was significantly associated with thirty-day death (P = .04).
CONCLUSION: In this national analysis, unplanned cranial reoperation was primarily associated with operative indices, rather than preoperative characteristics, suggesting that reoperation may have some utility as a quality indicator. However, hypertension and thrombocytopenia were potentially modifiable predictors of reoperation.

• 出版日期2017-11