title: The Impact of Surgical Experience on Major Intraoperative Aneurysm Rupture and Their Consequences on Outcome: A Multivariate Analysis of 538 Microsurgical Clipping Cases.
abstract: The incidence and associated mortality of major intraoperative rupture (MIOR) in intracranial aneurysm surgery is diverse. One possible reason is that many studies failed to consider and properly adjust the factor of surgical experience in the context. We conducted this study to clarify the role of surgical experience on MIOR and associated outcome. 538 consecutive intracranial aneurysm surgeries performed on 501 patients were enrolled in this study. Various potential predictors of MIOR were evaluated with stratified analysis and multivariate logistic regression. The impact of surgical experience and MIOR on outcome was further studied in a logistic regression model with adjustment of each other. The outcome was evaluated using the Glasgow Outcome Scale one year after the surgery. Surgical experience and preoperative Glasgow Coma Scale (GCS) were identified as independent predictors of MIOR. Experienced neurovascular surgeons encountered fewer cases of MIOR compared to novice neurosurgeons (MIOR, 18/225, 8.0% vs. 50/313, 16.0%, P = 0.009). Inexperience and MIOR were both associated with a worse outcome. Compared to experienced neurovascular surgeons, inexperienced neurosurgeons had a 1.90-fold risk of poor outcome. On the other hand, MIOR resulted in a 3.21-fold risk of unfavorable outcome compared to those without it. Those MIOR cases managed by experienced neurovascular surgeons had a better prognosis compared with those managed by inexperienced neurosurgeons (poor outcome, 4/18, 22% vs. 30/50, 60%, P = 0.013).
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chung-En
authors.initials: CE
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Tzu-Kang
authors.initials: TK
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Chiayi and Chang Gung Institute of Technology, Chiayi, Taiwan.
authors.forename: Ming-Hsueh
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chen-Nen
authors.initials: CN
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chih-Lung
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yung-Hsin
authors.initials: YH
authors.lastname: Hsu
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital-Linkou and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yin-Cheng
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Division of Neurosurgery, Saint Paul's Hospital, Taoyuan, Taiwan.
authors.forename: Tsung-Che
authors.initials: TC
authors.lastname: Hsieh
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality / Q000601:surgery*; D007431:Intraoperative Complications / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011364:Professional Practice; D012307:Risk Factors; D066231:Surgeons; D055815:Young Adult