Abstract
Introduction
Post-operative respiratory failure can occur after neurosurgical operations. Identification of risk factors for respiratory failure after neurosurgery may help guide clinical decision-making, decrease length of stay, improve patient outcomes, and lower costs.
Methods
We performed a search of the ACS-NSQIP database for all patients undergoing operations with a neurosurgeon from 2006 to 2013. We analyzed demographics, past medical history, and post-operative respiratory failure, defined as unplanned intubation and/or ventilator dependence for more than 48 h post-operatively.
Results
Of 94,621 NSQIP-reported neurosurgical patients from 2006 to 2013, 2325 (2.5 %) developed post-operative respiratory failure. Of these patients, 1270 (54.6 %) were male, with an overall mean age of 60.59 years; 571 (24.56 %) were current smokers and 756 (32.52 %) were ventilator-dependent. Past medical history included dyspnea in 204 patients (8.8 %), COPD in 198 (8.5 %), and congestive heart failure in 66 (2.8 %). The rate of post-operative respiratory failure decreased from 4.1 % in 2006 to 2.1 % in 2013 (p < 0.001). Of the 2325 patients with respiratory failure, 1061 (45.6 %) underwent unplanned intubation post-operatively and 1900 (81.7 %) were ventilator-dependent for more than 48 h. The rate of both unplanned intubation (p < 0.001) and ventilator dependence (p < 0.001) decreased significantly from 2006 to 2013. Multivariate analysis demonstrated that significant risk factors for respiratory failure included inpatient status (p < 0.001, OR = 0.165), age (p < 0.001, OR = 1.014), diabetes (p = 0.001, OR = 1.489), functional dependence prior to surgery (p < 0.001, OR = 2.081), ventilator dependence (p < 0.001, OR = 10.304), hypertension requiring medication (p = 0.005, OR = 1.287), impaired sensorium (p < 0.001, OR = 2.054), CVA/stroke with or without neurological deficit (p < 0.001, OR = 2.662; p = 0.002, OR = 1.816), systemic sepsis (p < 0.001, OR = 1.916), prior operation within 30 days (p = 0.026, OR = 1.439), and operation type (cranial relative to spine, p < 0.001, OR = 4.344, Table 4).
Conclusions
Based on the NSQIP database, risk factors for respiratory failure after neurosurgery include pre-operative ventilator dependence, alcohol use, functional dependence prior to surgery, stroke, and recent operation. The overall rate of respiratory failure decreased from 4.1 % in 2006 to 2.1 % in 2013 according to these data.
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Comment
This is an interesting study on the risk factors of post-operative respiratory failure (PRF), defined as an unplanned intubation or ventilator dependence for more than 48 h post-operatively. This manuscript provides interesting information obtained through a very large cohort of patients whose clinical data have been obtained from an US national registry. The data could be useful for neurosurgical anesthesiologist to improve their ability to predict post-operative respiratory status, but also for neurosurgons to anticipate the overall surgical outcome of patients. Included in the analysis, there are factors that are intuitively associated to PRF, such as a preoperative respiratory failure or a severe neurological deficit and/or impaired sensorium. The PRF is, in such cases, more than predictable and post-operative ventilator dependence an unavoidable condition rather than a post-surgical complication. Nonetheless, information provided by the authors is of distinct interest to neurosurgeons.
Alfredo Conti
Messina, Italy
Cote and coworkers provide an analysis of “risk factors for post-operative respiratory failure among 94,621 neurosurgical patients”, based on the ACS-NSQIP (American College of Surgeons-National Surgery Quality Improvement) database.
This is a retrospective analysis of a prospectively collected registry from 2006 to 2013. The limitations of this study design are adequately discussed by the authors. Even though the results are not surprising, the great number of patients included and the thorough analysis and discussion of the data presented warrant publication in my opinion.
Marcus Reinges
Giessen, Germany
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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Cote, D.J., Karhade, A.V., Burke, W.T. et al. Risk factors for post-operative respiratory failure among 94,621 neurosurgical patients from 2006 to 2013: a NSQIP analysis. Acta Neurochir 158, 1639–1645 (2016). https://doi.org/10.1007/s00701-016-2871-8
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DOI: https://doi.org/10.1007/s00701-016-2871-8