Incidence and Predictors of Complications and Mortality in Cerebrovascular Surgery: National Trends From 2007 to 2012.

BACKGROUND Cerebrovascular surgery offers potentially lifesaving treatments for intracranial vascular pathology yet bears substantial risks in the form of perioperative complications and mortality. OBJECTIVE To better characterize the risks associated with cerebrovascular surgery by broadly investigating the incidence of complications, patient-level predictors of complications, and mortality using the National Surgical Quality Improvement Program database, a prospective, audited, national data set. METHODS All cerebrovascular cases were extracted from the National Surgical Quality Improvement Program with the use of Current Procedural Terminology codes. Complication and mortality rates were analyzed with univariate and multivariate statistical analyses. RESULTS A total of 1141 cases were analyzed. The rate of complications was nearly twice that of previous estimates: Almost one-third of patients (30.9%) experienced at least 1 complication, which was significantly associated with 30-day mortality (odds ratio, 7.76; 95% confidence interval, 4.27-14.10; P < .001). Emergency surgery was associated with higher mortality rates (15.1%) than nonemergency procedures (2.3%). Significant predictors of complications included preoperative ventilator dependence, emergency surgery, bleeding disorders, diabetes mellitus, and alcohol abuse. Significant predictors of mortality included postoperative coma >24 hours, preoperative or postoperative ventilator dependence, black or Asian race, and stroke. The most common complications were ventilator dependence (64.5% in patients ventilated preoperatively, 8.4% in patients not ventilated preoperatively), bleeding requiring transfusion (10.2%), reoperation within 30 days (9.6%), pneumonia (7.3%), and stroke (7.3%). CONCLUSION Cerebrovascular surgery is associated with significant risks of morbidity and mortality. Mitigation of these risks requires broader, patient-centered understanding of risk factors and complications specific to cerebrovascular surgery, as presented in this article. These findings pave the way for improving patient safety and outcomes in cerebrovascular surgery. ABBREVIATIONS AVM, arteriovenous malformationCI, confidence intervalNSQIP, National Surgical Quality Improvement ProjectOR, odds ratio.

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