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  • Predictors of Inpatient Complications and Outcomes Following Surgical Resection of Hypothalamic Hamartomas

    Final Number:
    182

    Authors:
    Debraj Mukherjee MD, MPH; Miriam Nuno PhD; Christine Carico; Chirag G. Patil MD, MS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: We aimed to determine pre-operative factors associated with greater risk of inpatient complication and poor outcomes in a national population of patients undergoing surgical resection of hypothalamic hamartomas.

    Methods: We performed a multi-institutional retrospective cohort analysis via the Nationwide Inpatient Sample (1998-2007). Patients of any age who underwent resection of hypothalamic hamartomas were identified by ICD-9 coding. Primary outcomes included inpatient complications, length of stay (LOS), and total hospital charges. Multivariate logistic and linear regression models were constructed to analyze binary and continuous outcomes, respectively.

    Results: 282 patients were identified, with a mean age of 27.7 years old and a majority male 53.2%), Caucasian (78.9%), with private insurance (69.3%), and treated electively (74.7%) at academic centers (91.7%). A majority of patients (82.2%) had an Elixhauser comorbidity score of 1 or less, indicating relatively few comorbidities. No inpatient deaths were reported. Mean length of stay was 7.39 days, associated with mean total hospital charges of $53,935. Overall, 19.5% of patients developed an inpatient complication including primarily stroke (16.7%). Female gender, ethnic/racial minorities, higher comorbidity score, private insurance, and non-academic hospital status were associated with both greater length of stay and total charges. Private insurance (Odds Ratio, OR: 1.59, p=0.045) and academic hospital status (OR: 1.43, p=0.008) were associated with significantly higher odds of any inpatient complication. Post-operative stroke was significantly more likely to occur in minority race/ethnicity patients (OR: 1.02, p<0.001) relative to Caucasians.

    Conclusions: Through the analysis of a national database, we have demonstrated the relatively safety of the surgical resection of hypothalamic hamartomas. Over 10 years, these operations have been undertaken with a very low mortality rates, but a significant rate of inpatient morbidity, particularly post-operative stroke, may be predicted by several pre-operative factors including patient gender and race/ethnicity.

    Patient Care: The practicing neurosurgeon may be able to risk stratify their hypothalamic hamartoma patients toward surgical resection versus radiosurgical treatment using the risk factors identified in this study.

    Learning Objectives: 1. To identify the major inpatient complications and outcomes of patients undergoing surgical resection of hypothalamic hamartomas nationwide. 2. To identify risk factors associated with poor surgical outcomes within this patient population.

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