title: Predictors of 30-day perioperative morbidity and mortality of unruptured intracranial aneurysm surgery.
abstract: BACKGROUND
  Large-scale studies examining the incidence and predictors of perioperative complications after surgical clipping of unruptured intracranial aneurysms (UIA) using nationally representative prospectively collected data are lacking in the literature.
  
  
  METHODS
  Using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) dataset, we conducted a retrospective analysis of the complications experienced by patients that underwent surgical management of a UIA between the years of 2007 and 2013. The primary outcomes of interest were mortality within the 30-day perioperative period and adverse discharge disposition to a location other than home. Predictors of morbidity and mortality were elucidated using multivariable logistic regression analyses controlling for available patient demographic, comorbidity, and operative characteristics.
  
  
  RESULTS
  662 patients were identified in the ACS-NSQIP dataset for operative management of an unruptured aneurysm. The observed rates of 30-day mortality and adverse discharge disposition were 2.27% and 19.47%, respectively. A hundred and eight (16.31%) patients developed at least one major complication. On multivariable analysis, death within 30days was significantly associated with increased operative time (OR 1.005 per minute, 95% CI 1.002-1.008) and chronic preoperative corticosteroid use (OR 28.4, 95% CI 1.68-480.42), whereas major complication development was associated with increased operative time (OR 1.004 per minute, 95% CI 1.002-1.006), age (OR 1.017 per year, 95% CI 1-1.034), preoperative dependency (OR 3.3, 95% CI 1.16-9.40) and diabetes mellitus (OR 2.89, 95% CI 1.45-5.75). Lastly, increasing age (OR 1.017 per year, 95% CI 1-1.034) as well as ASA Class 3 (OR 1.73, 95% CI 1.08-2.77) and 4 (OR 2.28, 95% CI 1.1-4.72) were independent predictors of discharge to a location other than home.
  
  
  CONCLUSIONS
  Our study yields morbidity and mortality benchmarks for UIA surgery in a representative, national surgical registry. It will hopefully aid in recognizing those patients at greater risk for postoperative complications following surgical management, leading to appropriate changes in treatment strategies for this selected group of patients.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kerezoudis
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: McCutcheon
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Tarek
authors.initials: T
authors.lastname: Rayan
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gilder
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Rinaldo
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shepherd
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA.
authors.forename: Patrick R
authors.initials: PR
authors.lastname: Maloney
authors.affiliation: Department of Neurosurgery, University of California at San Diego, San Diego, CA, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Hirshman
authors.affiliation: Department of Neurosurgery, University of California at San Diego, San Diego, CA, USA.
authors.forename: Bob S
authors.initials: BS
authors.lastname: Carter
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA. Electronic address: Bydon.mohamad@mayo.edu.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Fredric
authors.initials: F
authors.lastname: Meyer
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Intracranial aneurysm; Morbidity; Mortality; Perioperative; Surgical clipping; Unruptured