Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection.
BACKGROUND
Respiratory failure and death are devastating outcomes in the postoperative period. Patients undergoing neurosurgical procedures experience a greater frequency of respiratory failure compared with other surgical specialties. Resection of infratentorial mass lesions may be associated with an even higher risk because of several unique factors. Our objectives were: (1) to determine the incidence of postoperative respiratory failure and death in the neurosurgical population; and (2) to determine whether infratentorial procedures are associated with a higher risk compared with supratentorial procedures.


METHODS
We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing intracranial tumor resection. The primary outcome was a composite of reintubation within 30 days, failure to wean from mechanical ventilation within 48 hours, and death within 30 days after surgery. We examined the association between the surgical site and the outcomes using multivariate logistic regression.


RESULTS
A total of 1699 patients met inclusion criteria (79% supratentorial and 21% infratentorial). The primary outcome occurred in 3.8% of supratentorial procedures and 6.6% of infratentorial procedures (P=0.02). Infratentorial tumor resection was independently associated with the composite outcome in the final model (odds ratio, 1.75; 95% confidence interval, 1.03-2.99; P=0.04) with the strongest association seen between infratentorial site and death (odds ratio, 2.44; 95% confidence interval, 1.23-4.87; P=0.01).


CONCLUSIONS
Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection. Mortality is an important contributor to this risk and should be a focus for future research.
*Department of Anesthesiology, Pharmacology and Therapeutics †Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC, Canada.
Alana M
AM
Flexman
Bradley
B
Merriman
Donald E
DE
Griesdale
Kelly
K
Mayson
Peter T
PT
Choi
Christopher J
CJ
Ryerson
D000368:Aged; D003399:Craniotomy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D015300:Ventilator Weaning