Predictors of Stroke and Coma After Neurosurgery: An ACS-NSQIP Analysis.
OBJECTIVE
The American College of Surgeons National Surgical Quality Improvement Program database aims to reduce 30-day postoperative complications. Reduction of postoperative stroke and coma can decrease length and cost of hospitalization, improve patient functional status, and decrease morbidity and mortality.


METHODS
We performed a search of the American College of Surgeons National Surgical Quality Improvement Program database for all patients from 2006 to 2013 undergoing an operation with a surgeon whose primary specialty was neurologic surgery.


RESULTS
Of 94,546 neurosurgical patients reported, there were 687 (0.73%) cases of postoperative stroke and coma. The annual rate of coma longer than 24 hours decreased from 0.90% in 2006 to 0.002% in 2013 (P < 0.001), and the annual rate of stroke decreased from 1.2% in 2006 to 0.5% in 2013 (P = 0.013). Multivariate analysis showed that inpatient status (P = 0.001; odds ratio [OR], 30.3), age (P = 0.005; OR, 1.012), history of diabetes (P = 0.017; OR, 1.515), ventilator dependence (P < 0.001; OR, 4.379), impaired sensorium (P < 0.001; OR, 2.314), history of coma longer than 24 hours (P < 0.001; OR, 2.655), hemiparesis (P = 0.022; OR, 1.492), cerebrovascular accident/stroke with neurologic deficit (P < 0.001; OR, 2.091), cerebrovascular accident/stroke without neurologic deficit (P = 0.001; OR, 2.44), and tumor involving central nervous system (P < 0.001; OR, 2.928) are significant risk factors for developing postneurosurgical stroke and coma.


CONCLUSIONS
The rate of postneurosurgical stroke decreased from 1.2% in 2006 to 0.5% in 2013 and the rate of postneurosurgical coma greater than 24 hours decreased from 0.9% in 2006 to 0.002% in 2013. Ten risk factors for developing postneurosurgical stroke and coma were identified using multivariable analysis. These risk factors should be assessed preoperatively and incorporated into clinical decision making so that individuals who are at higher risk for the development of stroke and coma can be appropriately monitored during the postoperative period.
Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Alexandra M G
AM
Larsen
Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: djcote15@gmail.com.
David J
DJ
Cote
Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Aditya V
AV
Karhade
Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Timothy R
TR
Smith
D017677:Age Distribution; D001932:Brain Neoplasms / Q000453:epidemiology*; D003128:Coma / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
Complications; NSQIP; Neurosurgery; Quality improvement