title: Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011.
abstract: OBJECTIVE
  Surgical complications increase the cost of health care worldwide and directly contribute to patient morbidity and mortality. In an effort to mitigate morbidity and incentivize best practices, stakeholders such as health insurers and the US government are linking reimbursement to patient outcomes. In this study the authors analyzed a national database to determine basic metrics of how comorbidities specifically affect the subspecialty of neurosurgery.
  
  
  METHODS
  Data on 1,777,035 patients for the years 2006-2011 were acquired from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as "neurological surgery." Univariate statistics were calculated using the chi-square test, and 95% confidence intervals were determined for the resultant risk ratios. A multivariate model was constructed using significant variables from the univariate analysis (p < 0.05) with binary logistic regression.
  
  
  RESULTS
  Over 38,000 neurosurgical cases were analyzed, with complications occurring in 14.3%. Cranial cases were 2.6 times more likely to have complications than spine cases, and African Americans and Asians/Pacific Islanders were also at higher risk. The most frequent complications were bleeding requiring transfusion (4.5% of patients) and reoperation within 30 days of the initial operation (4.3% of patients), followed by failure to wean from mechanical ventilation postoperatively (2.5%). Significant predictors of complications included preoperative stroke, sepsis, blood transfusion, and chronic steroid use.
  
  
  CONCLUSIONS
  Understanding the landscape of neurosurgical complications will allow better targeting of the most costly and harmful complications of preventive measures. Data from the ACS NSQIP database provide a starting point for developing paradigms of improved care of neurosurgical patients.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California.
authors.forename: John D
authors.initials: JD
authors.lastname: Rolston
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Lau
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000191:economics* / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality*; D011237:Predictive Value of Tests; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data; D012086:Reoperation / Q000191:economics / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000191:economics / Q000706:statistics & numerical data; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States / Q000453:epidemiology