title: Impact of operative length on post-operative complications in meningioma surgery: a NSQIP analysis.
abstract: Many studies have implicated operative length as a predictor of post-operative complications, including venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)]. We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, to evaluate whether length of operation had a statistically significant effect on post-operative complications in patients undergoing surgical resection of meningioma. Patients were included for this study if they had a post-operative diagnosis of meningioma. Patient demographics, pre-operative comorbidities, and post-operative 30-day complications were analyzed. Of 3743 patients undergoing craniotomy for meningioma, 13.6 % experienced any complication. The most common complications and their median time to occurrence were urinary tract infection (2.6 %) at 10 days postoperatively (IQR 7-15), unplanned intubation (2.5 %) at 3 days (IQR 1-7), failure to wean from ventilator (2.4 %) at 2.0 days (IQR 2-4), and DVT (2.4 %) at 6 days (IQR 11-19). Postoperatively, 3.6 % developed VTE; 2.4 % developed DVT and 1.7 % developed PE. Multivariable analysis identified older age (third and upper quartile), obesity, preoperative ventilator dependence, preoperative steroid use, anemia, and longer operative time as significant risk factors for VTE. Separate multivariable logistic regression models demonstrated longer operative time as a significant risk factor for VTE, all complications, major complications, and minor complications. Meningioma resection is associated with various post-operative complications that increase patient morbidity and mortality risk. this large, multi-institutional patient sample, longer operative length was associated with increased risk for postoperative venous thromboembolisms, as well as major and minor complications.
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Aditya V
authors.identifier: 0000-0002-6026-4361
authors.initials: AV
authors.lastname: Karhade
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Fandino
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Saksham
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cote
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Julian B
authors.initials: JB
authors.lastname: Iorgulescu
authors.affiliation: Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: Marike L
authors.initials: ML
authors.lastname: Broekman
authors.affiliation: Department of Anesthesiology, Perioperative, and Pain Medicine, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Aglio
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.affiliation: Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. TRSMITH@PARTNERS.ORG.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008577:Meningeal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008579:Meningioma / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology
keywords: Complications; Meningioma; NSQIP; Neurosurgery; Operation length; Outcomes; Surgical outcomes research