Outcomes after craniotomy for resection of craniopharyngiomas in adults: analysis of the National Surgical Quality Improvement Program (NSQIP)
Outcomes after craniotomy for resection of craniopharyngiomas in adults: analysis of the National Surgical Quality Improvement Program (NSQIP)
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DOI：
10.1007/s11060-019-03209-9
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发表时间：
2019-08-01
影响因子：
3.9
通讯作者：
Broaddus, William C.
中科院分区：
文献类型：
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作者：
Rock, Andrew K.;Dincer, Alper;Broaddus, William C.
目的颅咽管瘤发生在鞍上位置，给手术治疗带来挑战。本研究评估成人颅咽管瘤开颅手术后并发症的发生率，并调查这些并发症的危险因素。方法从2005-2016年美国外科医生学会国家手术质量改进计划（ACS-NSQIP）中筛选出接受开颅手术切除颅咽管瘤的患者。确定术后 30 天并发症的发生率。多变量逻辑回归确定了与任何并发症和主要（Clavien IV）并发症相关的人口统计学、合并症和围手术期特征。结果共确定了 143 例病例。 51 人 (35.7%) 出现并发症，20 人 (14.0%) 出现严重并发症，4 人 (2.8%) 死亡。最常见的并发症是：非计划再入院（13.3%）、长时间通气>48小时（9.8%）和非计划再次手术（9.3%）。在多变量分析中，与任何并发症显着相关的变量为：黑人种族（OR 0.16；95% CI 0.03-0.84；p=0.03）、高血压（OR 5.04；95% CI 1.79-14.17；p=0.002）和较长的手术时间（OR 1.27；95% CI 1.01-1.58；p=0.002）。 p=0.04）。高血压（OR 9.33；95% CI 1.61-54.21；p=0.01）和较长的手术时间（OR 1.51；95% CI 1.05-2.17；p=0.03）也是主要并发症的重要预测因素。 结论 三分之一接受开颅颅咽管瘤切除术的患者出现术后并发症。虽然很高，但与之前报告的三分之二的比率形成鲜明对比。手术时间延长和高血压是主要并发症的积极预测因素。这些信息可以帮助为患者提供咨询和管理决策。我们注意到其他治疗方法，例如内窥镜手术技术、放射外科和放射治疗可能具有不同的特征和并发症的预测因素。
PurposeCraniopharyngiomas occur in suprasellar locations that pose challenges for surgical management. This study evaluates the incidence of complications following craniotomy for craniopharyngioma in adults and investigates risk factors for these complications.MethodsPatients who underwent craniotomy for excision of craniopharyngioma were identified from the 2005-2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Incidence of 30-day postoperative complications was determined. Multivariable logistic regression identified demographic, comorbid and perioperative characteristics associated with any complication and major (Clavien IV) complications.ResultsThere were 143 cases identified. Fifty-one (35.7%) had a complication, twenty (14.0%) experienced a major complication and there were four (2.8%) deaths. The most common complications were: unplanned readmission (13.3%), prolonged ventilation>48h (9.8%), and unplanned reoperation (9.3%). In multivariable analysis, variables significantly associated with any complication were: black race (OR 0.16; 95% CI 0.03-0.84; p=0.03), hypertension (OR 5.04; 95% CI 1.79-14.17; p=0.002) and longer duration of surgery (OR 1.27; 95% CI 1.01-1.58; p=0.04). Hypertension (OR 9.33; 95% CI 1.61-54.21; p=0.01) and longer duration of surgery (OR 1.51; 95% CI 1.05-2.17; p=0.03) were also significant predictors for major complications.ConclusionOne-third of patients undergoing craniotomy for craniopharyngioma resection experienced a postoperative complication. While high, this contrasts previously reported rates of two-thirds. Prolonged operative time and hypertension are positive predictors of major complications. This information can assist in counseling patients and decision-making for management. We note that other treatment approaches, such as endoscopic surgical techniques, radiosurgery and radiation therapy likely have different profiles and predictors of complications.