Surgery for Cerebellar Hemorrhage – a NSQIP-Database Analysis of Patient Outcomes and Factors Associated with 30-Day Mortality and Prolonged Ventilation.

World Neurosurg. 2017 Jul 19. pii: S1878-8750(17)31141-5. doi: 10.1016/j.wneu.2017.07.041. [Epub ahead of print]

Surgery for Cerebellar Hemorrhage – a NSQIP-Database Analysis of Patient Outcomes and Factors Associated with 30-Day Mortality and Prolonged Ventilation.

Abstract

OBJECTIVE:

Primary cerebellar hemorrhage accounts for 10% of all intracranial hemorrhages. Given the confined space of the posteriorfossa, cerebellar hemorrhage management sometimes necessitates suboccipital decompression and hematoma evacuation. In this study, we examine outcomes following surgery for primary cerebellar hemorrhage, and identify risk factors associated with adverse outcomes.

METHODS:

A retrospective review of the 2005-2014 ACS-NSQIP database was performed, with CPT Code 61315 (suboccipital craniectomy or craniotomy for evacuation of cerebellar hemorrhage) queried between 2005 and 2014. Patient demographics, preoperative comorbidities, and 30-day outcomes were analyzed. Univariate and multivariate regression analyses were performed to identify predictors of mortality and adverse events.

RESULTS:

158 craniotomies were studied, with a 30-day mortality rate of 26.6%. The most common adverse events included ventilator dependence after 48 hours (48.7%) and pneumonia (24.1%). Almost one quarter (24.7%) of patients required additional operations, with 8.5% of patients undergoing repeat craniotomy. Death was associated with premorbid dependent functional status (P = 0.005), ASA class (P = 0.010), and history of CHF (P = 0.031). Prolonged ventilation was associated with premorbid functional status (P = 0.043) and ventilator dependence (P = 0.007) prior to surgery.

CONCLUSIONS:

Cerebellar hemorrhage is associated with significant risk of mortality and ventilator dependence. In patients that require surgery, 30-day mortality risk remains high (26.6%), with functional status and ASA class predictive of death.

KEYWORDS:

ACS; ASA; American College of Surgeons; American Society of Anesthesiologists; CHF; CPT; Cerebellar Hemorrhage; Congestive Heart Failure; Current Procedural Terminology; Functional Status; GCS; Glasgow Coma Scale; ICD; International Classification of Disease; Mortality; NSQIP; National Surgical Quality Improvement Program; Posterior Fossa; Ventilator Dependence

PMID:
28735123
DOI:
10.1016/j.wneu.2017.07.041


Categories: Brain Trauma and NeuroCritical Care, Vascular

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