Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) maintains a large, randomized dataset with up to 30-day post-operative complications. The extensive neurosurgical records allowed us to identify the most common neurosurgical procedures and post-operative complications to have maximal impact on improving surgical outcomes.
Methods: We performed a search of the ACS-NSQIP database from 2006 to 2014 for patients who underwent an operation with a surgeon whose primary specialty was neurosurgery. We determined the five most performed procedures and performed univariate, bivariate, and multivariate analysis of demographics, past medical history, and post-operative complications for these procedures.
Results: The five most common neurosurgical procedures in the NSQIP database from 2006 to 2014 were anterior cervical discectomy and fusion (ACDF), craniotomy for brain tumor (CBT), discectomy, laminectomy, and posteriorlateral lumbar fusion (PLF). The most common complications overall were urinary tract infection (UTI) (1.3%), superficial surgical site infection (SSSI) (0.8%), deep vein thrombosis (DVT) (0.8%), sepsis (0.7%) and pneumonia (0.7%). The most common complications for ACDF were pneumonia (0.7%), UTI (0.6%), unplanned intubation (0.6%), SSSI (0.4%), and sepsis, DVT/thrombophelbitis, and ventilator dependence greater than 48 hours (0.3%). The most common complications for CBT were DVT (2.5%), UTI (2.4%), unplanned intubation (1.9%), ventilator dependence greater than 48 hours (1.7%) and pneumonia (1.6%). and for discectomy were UTI (1.1%), sepsis (1.0%), SSSI (0.8%), deep incisional surgical site infection (DSSI) (0.6%), and DVT and unplanned intubation (0.5%). The most common complications for laminectomy were UTI (1.1%), SSRI (0.9%), DSSI (0.6%), sepsis (0.5) and DVT (0.4%) and for PLF were UTI (1.8%), SSSI (1.1%) and DVT, sepsis, and DSSI (0.8%).
Conclusions: The identification of the five most common neurosurgical procedures and associated complications may improve quality of care by incorporating this knowledge into clinical decisions to ultimately decrease morbidity, mortality, and post-operative complications after neurosurgery.
Patient Care: We hope that with the identification of the most common neurosurgical procedures and associated post-operative complications that the knowledge will be integrated into clinical decision making. Our hope is to draw attention to these complications in order to determine strategies to lower the complication rate.
Learning Objectives: By the conclusion of this session, participants should be able to 1.) Identify the most common neurosurgical procedures and post-operative complications 2.) Discuss how to best reduce these complications (ex. surgical checklist implementation)