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  • Complications in Neurological Surgery: Nationwide Trends in Morbidity from 2005-2010

    Final Number:

    John David Rolston MD, PhD; Catherine Lau MD; Rita Mistry; Andrew T. Parsa MD PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Medical errors lead to nearly 100,000 deaths and $6 billion in extraneous costs annually. Despite this impact, medical errors and complications have largely escaped investigation in neurological surgery. Here, we use the National Surgical Quality Improvement Program (NSQIP) database to quantify neurosurgical complications. The NSQIP database includes cases from >200 hospitals, collected by trained raters in an unbiased manner.

    Methods: Data were acquired from the NSQIP database public use file. All procedures whose primary surgeon was identified as a neurosurgeon were extracted. Analysis was conducted using Matlab 2011b (Mathworks Inc., Natick, MA). Data are reported as mean ± SEM.

    Results: Complications were reported in 11.1% of 20,564 cases studied. Complications were significantly more likely in cranial (20.2%) than spinal surgery (7.9%; RR 10.7, 95% CI 10.1 to 11.4). However, the ASA class of cranial patients significantly exceeded that of spinal patients (2.88 ± 0.01 vs. 2.40 ± 0.01, P < 0.00001). The most frequent complication across all procedures was prolonged intubation, occurring in 2.6% of patients, followed by a requirement for blood transfusions (2.5%), urinary tract infections (2.3%), and sepsis (1.7%). All of these complications, individually, were more common in cranial than spinal procedures. Complications frequently associated with neurosurgery—stroke and coma—were less common: stroke occurred in 0.7% of patients and coma lasting >24 hours in 0.3%. Again, these complications were more common in cranial than spinal procedures, with stroke occurring in 2.2% and coma in 1.3% of cranial cases.

    Conclusions: Reported complications are more common in cranial than spinal procedures, and this may relate to the lower ASA class found in cranial patients. Interestingly, the most common complication was prolonged intubation. Understanding the most frequent complications in neurological surgery will allow us to better counsel patients and better design targeted interventions to improve patient outcomes.

    Patient Care: In order to best improve the quality of our patient care, we must first recognize the most common and costly medical complications our specialty produces. By using a nationwide database, we can empirically quantify which complications most affect our patients, and then better design targeted interventions to address these issues, improving patient outcomes.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) identify the costs of preventable medical error and complications, 2) understand the difficulties in defining errors and complications, and 3) appreciate the frequency of different complications in cranial and spinal neurosurgery.


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