title: The semisitting position: analysis of the risks and surgical outcomes in a contemporary series of 425 adult patients undergoing cranial surgery.
abstract: OBJECTIVE The objective of this study was to analyze the incidence of the primary complications related to positioning or surgery and their impact on neurological outcome in a consecutive series of patients undergoing elective surgery in the semisitting position. METHODS The authors prospectively collected and retrospectively analyzed data from adult patients undergoing elective surgery in the semisitting position for a cranial disease. Patients were managed perioperatively according to a standard institutional protocol, a standardized stepwise positioning, and surgical maneuvers to decrease the risk of venous air embolism (VAE) and other complications. Intraoperative and postoperative complications were recorded. Neurointensive care unit (NICU) length of stay (LOS) and hospital LOS were the intermediate endpoints. Neurological outcome was the primary endpoint as determined by the modified Rankin scale (mRS) score at 6 months after surgery. RESULTS Four hundred twenty-five patients were included in the analysis. VAE occurred in 90 cases (21%) and it made no significant statistical difference in NICU LOS, hospital LOS, and neurological outcome. No complication was directly related to the semisitting position, although 46 patients (11%) experienced at least 1 surgery-related complication and NICU LOS and hospital LOS were significantly prolonged in this group. Neurological outcome was significantly worse for patients with complications (p < 0.0001). CONCLUSIONS Even in the presence of intraoperative VAE, the semisitting position was not related to an increased risk of postoperative deficits and can represent a safe additional option for the benefit of specific surgical and patient needs.
authors.affiliation: Department of Neurosurgery.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saladino
authors.affiliation: Neuro-Intensive Care Unit.|Anesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lamperti
authors.affiliation: Department of Neurosurgery.|Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mangraviti
authors.affiliation: Department of Neurosurgery.
authors.forename: Federico G
authors.initials: FG
authors.lastname: Legnani
authors.affiliation: Department of Neurosurgery.
authors.forename: Francesco U
authors.initials: FU
authors.lastname: Prada
authors.affiliation: Department of Neurosurgery.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Casali
authors.affiliation: Department of Neurology, Cerebrovascular Diseases Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Caputi
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Italy; and.
authors.forename: Paola
authors.initials: P
authors.lastname: Borrelli
authors.affiliation: Department of Neurosurgery.|Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland.
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D056888:Patient Positioning / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D000077708:Sitting Position; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: ASA = American Society of Anesthesiologists; BMI = body mass index; IQR = interquartile range; LOS = length of stay; NICU = neurointensive care unit; PACU = postanesthesia care unit; PFO = patent foramen ovale; VAE = venous air embolism; diagnostic technique; mRS = modified Rankin Scale; outcome; posterior fossa lesion; semisitting position; skull base; surgical complications; venous air embolism