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Drapeau AI, Mpody C, Gross MA, Lemus R, Tobias JD, Nafiu O. Factors Associated With Unplanned Post-Craniotomy Re-intubation in Children: A NSQIP-Pediatric ® Analysis. J Neurosurg Anesthesiol 2024; 36:37-44. [PMID: 36136605 DOI: 10.1097/ana.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Most children undergoing craniotomy with general endotracheal anesthesia are extubated postoperatively, but some require unplanned postoperative intubation (UPI). We sought to determine the incidence of UPI and identify associated factors and related postoperative mortality. METHODS The National Surgical Quality Improvement Program for Pediatrics (2012-2018) was used to retrospectively identify patients less than 18 years old who underwent craniotomy for epilepsy, tumor, and congenital/cyst procedures. Perioperative factors associated with UPI were identified with logistic regression models. RESULTS We identified 15,292 children, of whom 144 (0.94%) required UPI. Ninety-two (0.60%) children required UPI within the first 3 days after surgery. Postoperative mortality was higher among children with UPI within 3 days than in those with UPI later or not at all (8.0 vs. 2.2 vs. 0.3%, respectively; P <0.001). Posterior fossa procedures trended towards an increased odds of UPI (odds ratio [OR], 1.50; 95% confidence interval [CI] 0.99 to 2.27; P =0.05). Five preoperative factors were independently associated with UPI: age ≤ 12 months (OR, 2.78; 95% CI, 1.29 to 5.98), ASA classification ≥3 (OR, 1.92; 95% CI, 1.12 to 3.29), emergent case status (OR, 2.06; 95% CI, 1.30 to 3.26), neuromuscular disease (OR, 1.87; 95% CI, 1.01 to 3.47), and steroid use within 30 days (OR, 1.79; 95% CI 1.14 to 2.79). Long operative times were independently associated with UPI (200 to 400 vs. <200 min OR, 1.92; 95% CI 1.18 to 3.11 and ≥400 vs. <200 min OR, 4.66; 95% CI 2.70 to 8.03). CONCLUSION Although uncommon, UPI in children who underwent craniotomy was associated with an elevated risk of postoperative mortality. The presence of identifiable risk factors may be used for preoperative counseling and risk profiling in these patients.
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Affiliation(s)
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, and The Ohio State University College of Medicine
| | - Michael A Gross
- Heritage College of Osteopathic Medicine, Dublin Campus, Ohio University, Dublin, OH
| | - Rafael Lemus
- Department of Pediatrics, Nationwide Children's Hospital, Columbus
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, and The Ohio State University College of Medicine
| | - Olubukola Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, and The Ohio State University College of Medicine
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da Silva AR, Novais MCM, Neto MG, Correia HF. Predictors of extubation failure in neurocritical patients: A systematic review. Aust Crit Care 2023; 36:285-291. [PMID: 35197209 DOI: 10.1016/j.aucc.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 11/02/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify predictors of extubation failure in neurocritical patients. METHODS This was systematic review performed through a bibliographic search of the databases PubMed/Medline, Lilacs, SciELO, and Web of Science, from February 2020 to October 2021. Cohort studies that investigated the predictors of extubation failure were included, defined as the need for reintubation within 48 h after extubation, in adult neurocritical patients. The risk-of-bias assessment was performed using the Newcastle-Ottawa Scale, for cohort studies. RESULTS Eight studies, totaling 18 487 participants, were included. A total of 15 predictors for extubation failure in neurocritical patients have been identified. Of these, four were the most frequent: low score on the Glasgow Coma Scale (motor score ≤5, 8T-10T), female gender, time on mechanical ventilation (≥7 days, ≥ 10 days), and moderate or large secretion volume. CONCLUSIONS In addition to the conventional parameters of weaning and extubation, other factors, such as a low score on the Glasgow Coma Scale, female gender, mechanical ventilation time, and moderate or large secretion volume, must be taken into account to prevent extubation failure in neurocritical patients in clinical practice.
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Affiliation(s)
- Alanna Ribeiro da Silva
- Physiotherapy Department, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil.
| | - Michelli Christina Magalhães Novais
- Graduate Program in Interactive Processes of Organs and Systems, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil
| | - Mansueto Gomes Neto
- Physiotherapy Department, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil
| | - Helena França Correia
- Physiotherapy Department, Federal University of Bahia (UFBA), Av. Adhemar de Barros, s/nº - Ondina, Salvador, Bahia, CEP 40170-110, Brazil
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Springborg JB, Lang JM, Fugleholm K, Poulsgaard L. Face-to-face four hand technique in vestibular schwannoma surgery: results from 256 Danish patients with larger tumors. Acta Neurochir (Wien) 2020; 162:61-69. [PMID: 31768756 DOI: 10.1007/s00701-019-04148-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to investigate the clinical outcome after microsurgical treatment of vestibular schwannomas using face-to-face four hand technique in 256 Danish patients treated in the Department of Neurosurgery at the Copenhagen University Hospital from 2009 to 2018. METHODS Data were retrospectively collected from patient records. RESULTS The mean tumor size was 30.6 mm and approximately 46% of the patients had tumors >30 mm. In around 1/3 of the patients a retrosigmoid approach was used and in 2/3 a translabyrinthine. In 50% of the patients, the tumor was completely removed, and in 38%, only smaller remnants were left to preserve facial function. The median operative time was approximately 2.5 h for retrosigmoid approach, and for translabyrinthine approach, it was around 3.5 h. One year after surgery, 84% of the patients had a good facial nerve function (House-Brackmann grade 1-2). In tumors ≤ 30 mm approximately 89% preserved good facial function, whereas this was only the case for around 78% of the patients with tumors > 30 mm. In 60% of the patients who had poor facial nerve function at hospital discharge, the function improved to good facial function within the 1 year follow-up period. Four patients died within 30 days after surgery, and 6% underwent reoperation for cerebrospinal fluid leakage. CONCLUSION Surgery for vestibular schwannomas using face-to-face four hand technique may reduce operative time and can be performed with lower risk and excellent facial nerve outcome. The risk of surgery increases with increasing tumor size.
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Affiliation(s)
| | - Jeppe Mathias Lang
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, Copenhagen University Hospital, DK-2100, Copenhagen, Denmark
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Nguyen AV, Coggins WS, Jain RR, Branch DW, Allison RZ, Maynard K, Lall RR. Effect of an additional neurosurgical resident on procedure length, operating room time, estimated blood loss, and post-operative length-of-stay. Br J Neurosurg 2019; 34:611-615. [PMID: 31328574 DOI: 10.1080/02688697.2019.1642446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Neurosurgical residency training is costly, with expenses largely borne by the academic institutions that train residents. One expense is increased operative duration, which leads to poorer patient outcomes. Although other studies have assessed the effect of one resident assisting, none have investigated two residents; thus, we sought to investigate if two residents versus one scrubbed-in impacted operative time, estimated blood loss (EBL), and length-of-stay (LOS).Methods: In this retrospective review of patients who underwent a neurosurgical procedure involving one or two residents between January 2013 and April 2016, we performed multivariable linear regression to determine if there was an association between resident participation and case length, operating room time, EBL, and LOS. We also included patient demographics, attending surgeon, day of the week, start time, pre-operative LOS, procedure performed, and other variables in our model. Only procedures performed at least 40 times during the study period were analyzed.Results: Of 860 procedures that met study criteria, 492 operations were one of six procedures performed at least 40 times, which were anterior cervical discectomy and fusion, cerebrospinal fluid (CSF) shunt insertion, CSF shunt revision, lumbar laminectomy, intracranial hematoma evacuation, and non-skull base, supratentorial parenchymal brain tumor resection. An additional resident was associated with a 35.1-min decrease (p = .01) in operative duration for lumbar laminectomies. However, for intracranial hematoma evacuations, an extra resident was associated with a 24.1 min increase (p = .03) in procedural length. There were no significant differences observed in the other four surgeries.Conclusion: An additional resident may lengthen duration of intracranial hematoma evacuations. However, two residents scrubbed-in were associated with decreased lumbar laminectomy duration. Overall, an extra resident does not increase procedural duration, total operating room utilization, EBL, or post-operative LOS. Allowing two residents to scrub in may be a safe and cost-effective method of educating neurosurgical residents.
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Affiliation(s)
- Anthony V Nguyen
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - William S Coggins
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rishabh R Jain
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel W Branch
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Randall Z Allison
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ken Maynard
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rishi R Lall
- Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX, USA
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Predictors of Stroke and Coma After Neurosurgery: An ACS-NSQIP Analysis. World Neurosurg 2016; 93:299-305. [DOI: 10.1016/j.wneu.2016.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/18/2022]
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Cai YH, Wang HT, Zhou JX. Perioperative Predictors of Extubation Failure and the Effect on Clinical Outcome After Infratentorial Craniotomy. Med Sci Monit 2016; 22:2431-8. [PMID: 27404044 PMCID: PMC4944551 DOI: 10.12659/msm.899780] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of the study was to analyze the risk factors for failed extubation in subjects submitted to infratentorial craniotomy. MATERIAL AND METHODS Patients aged over 18 years who received infratentorial craniotomy for brain tumor resection were consecutively included in this study. Perioperative variables were collected and analyzed. Univariate analyses and multiple logistic regression were used to derive factors related to failed extubation. Patients had follow-up care until either out of hospital or death. RESULTS Throughout the course of the study, 2118 patients were eligible and 94 (4.4%) suffered from extubation failure at some point during their hospital stay. Five factors were recognized as independent risk factors for postoperative failed extubation: craniotomy history, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in blood pressure (BP) during the operation. Failed extubation was related to a higher incidence rate of pneumonia, mortality, unfavorable Glasgow Outcome Scale score, longer stay in the neuro-intensive care unit (ICU) and hospitalization, and higher hospitalization costs compared with successful extubation. CONCLUSIONS History of craniotomy, preoperative lower cranial nerve dysfunction, tumor size, tumor position, and maximum change in BP during the operation were independent risk factors related to postoperative failed extubation in patients submitted to infratentorial craniotomy. Extubation failure raises the incidences of postoperative pneumonia, mortality, and higher hospitalization costs, and prolongs neuro-ICU and postoperative length of stay.
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Affiliation(s)
- Ye-Hua Cai
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Hai-Tang Wang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
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Murphy ME, McCutcheon BA, Kerezoudis P, Porter A, Rinaldo L, Shepherd D, Rayan T, Maloney PR, Carter BS, Bydon M, Gompel JJV, Link MJ. Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms. Clin Neurol Neurosurg 2016; 148:105-9. [PMID: 27434528 DOI: 10.1016/j.clineuro.2016.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Obesity has been associated with increased risk for postoperative CSF leak in patients with benign cranial nerve tumors. Other measures of postoperative morbidity associated with obesity have not been well characterized. METHODS Patients enrolled in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013 with a diagnosis code of a benign neoplasm of a cranial nerve were included. The primary outcome of postoperative morbidity was analyzed as well as secondary outcomes of readmission and reoperation. The main covariate of interest was body mass index (BMI). RESULTS A total of 561 patients underwent surgery for a benign cranial nerve neoplasm between 2007 and 2013. Readmission data, available for 2012-2013(n=353), revealed hydrocephalus, facial nerve injury, or CSF leak requiring readmission or reoperation occurred in 0.85%, 1.42%, and 3.12%, respectively. Composite morbidity included wound complications, infection, respiratory insufficiency, transfusion requirement, stroke, venous thromboembolism, coma and cardiac arrest. On multivariable analysis patients with class I (BMI 30-34.9) and II (BMI 35-39.9) obesity showed trends towards increasing return to operating room, though not significant, but there was no trend for composite complications in class I and II obesity patients. However, class III obesity, BMI≥40, was associated with increased odds of composite morbidity (OR 4.40, 95% CI 1.24-15.88) and return to the operating room (OR 5.97, 95% CI 1.20-29.6) relative to patients with a normal BMI, 18.5-25. CONCLUSIONS Obesity is an independent and important risk factor for composite morbidity in resection of benign cranial nerve neoplasms, and as such, merits discussion during preoperative counseling.
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Affiliation(s)
- Meghan E Murphy
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Brandon A McCutcheon
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Panagiotis Kerezoudis
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Amanda Porter
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Lorenzo Rinaldo
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Daniel Shepherd
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Tarek Rayan
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA; Department of Neurosurgery, Alexandria, Egypt.
| | - Patrick R Maloney
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Bob S Carter
- Department of Neurologic Surgery, University of San Diego, San Diego, CA, USA.
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, USA.
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Is Patient Age Associated with Perioperative Outcomes After Surgical Resection of Benign Cranial Nerve Neoplasms? World Neurosurg 2016; 89:101-7. [DOI: 10.1016/j.wneu.2016.01.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/27/2016] [Indexed: 11/21/2022]
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Murphy M, Gilder H, McCutcheon BA, Kerezoudis P, Rinaldo L, Shepherd D, Maloney P, Snyder K, Carlson ML, Carter BS, Bydon M, Van Gompel JJ, Link MJ. Increased Operative Time for Benign Cranial Nerve Tumor Resection Correlates with Increased Morbidity Postoperatively. J Neurol Surg B Skull Base 2016; 77:350-7. [PMID: 27441161 DOI: 10.1055/s-0036-1572508] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/09/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Operative time, previously identified as a risk factor for postoperative morbidity, is examined in patients undergoing benign cranial nerve tumor resection. DESIGN/SETTING/PARTICIPANTS This retrospective cohort analysis included patients enrolled in the ACS-NSQIP registry from 2007 through 2013 with a diagnosis of a benign cranial nerve neoplasm. MAIN OUTCOME MEASURES Primary outcomes included postoperative morbidity and mortality. Readmission and reoperation served as secondary outcomes. RESULTS A total of 565 patients were identified. Mean (median) operative time was 398 (370) minutes. The 30-day complication, readmission, and return to the operating room rates were 9.9%, 9.9%, and 7.3%, respectively, on unadjusted analyses. CSF leak requiring reoperation or readmission occurred at a rate of 3.1%. On multivariable regression analysis, operations greater than 413 minutes were associated with an increased odds of overall complication (OR 4.26, 95% CI 2.08-8.72), return to the operating room (OR 2.65, 95% CI 1.23-5.67), and increased length of stay(1.6 days, 95% CI 0.94-2.23 days). Each additional minute of operative time was associated with an increased odds of overall complication (OR 1.004, 95% CI 1.002-1.006) and increased length of stay (0.006 days, 95% CI 0.004-0.008). CONCLUSION Increased operative time in patients undergoing surgical resection of a benign cranial nerve neoplasm was associated with an increased rate of complications.
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Affiliation(s)
- Meghan Murphy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Hannah Gilder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Brandon A McCutcheon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Lorenzo Rinaldo
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Shepherd
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Patrick Maloney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kendall Snyder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Bob S Carter
- Department of Neurologic Surgery University of California, San Diego, United States
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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