Surgery for Cerebellar Hemorrhage: A National Surgical Quality Improvement Program Database Analysis of Patient Outcomes and Factors Associated with 30-Day Mortality and Prolonged Ventilation

Gregory Arnone, Darian R. Esfahani, Matt Wonais, Prateek Kumar, Justin K. Scheer, Ali Alaraj, Sepideh Amin-Hanjani, Fady T. Charbel, Ankit I. Mehta

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective Primary cerebellar hemorrhage accounts for 10% of all intracranial hemorrhages. Given the confined space of the posterior fossa, cerebellar hemorrhage management sometimes necessitates suboccipital decompression and hematoma evacuation. In this study, we examine outcomes after surgery for primary cerebellar hemorrhage and identify risk factors associated with adverse outcomes. Methods A retrospective review of the 2005–2014 American College of Surgeons-National Surgical Quality Improvement Program database was performed, with Current Procedural Terminology 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 A total of 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), American Society of Anesthesiologists class (P = 0.010), and history of congestive heart failure (P = 0.031). Prolonged ventilation was associated with premorbid functional status (P = 0.043) and ventilator dependence (P = 0.007) before surgery. Conclusions Cerebellar hemorrhage is associated with significant risk of mortality and ventilator dependence. In patients who require surgery, 30-day mortality risk remains high (26.6%), with functional status and American Society of Anesthesiologists class predictive of death.

Original languageEnglish (US)
Pages (from-to)543-550
Number of pages8
JournalWorld neurosurgery
Volume106
DOIs
StatePublished - Oct 1 2017

Fingerprint

Quality Improvement
Ventilation
Craniotomy
Mechanical Ventilators
Databases
Hemorrhage
Mortality
Intracranial Hemorrhages
Confined Spaces
Current Procedural Terminology
Decompression
Ambulatory Surgical Procedures
Hematoma
Comorbidity
Pneumonia
Multivariate Analysis
Heart Failure
Regression Analysis
Demography

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Arnone, Gregory ; Esfahani, Darian R. ; Wonais, Matt ; Kumar, Prateek ; Scheer, Justin K. ; Alaraj, Ali ; Amin-Hanjani, Sepideh ; Charbel, Fady T. ; Mehta, Ankit I. / Surgery for Cerebellar Hemorrhage : A National Surgical Quality Improvement Program Database Analysis of Patient Outcomes and Factors Associated with 30-Day Mortality and Prolonged Ventilation. In: World neurosurgery. 2017 ; Vol. 106. pp. 543-550.
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title = "Surgery for Cerebellar Hemorrhage: A National Surgical Quality Improvement Program 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 posterior fossa, cerebellar hemorrhage management sometimes necessitates suboccipital decompression and hematoma evacuation. In this study, we examine outcomes after surgery for primary cerebellar hemorrhage and identify risk factors associated with adverse outcomes. Methods A retrospective review of the 2005–2014 American College of Surgeons-National Surgical Quality Improvement Program database was performed, with Current Procedural Terminology 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 A total of 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), American Society of Anesthesiologists class (P = 0.010), and history of congestive heart failure (P = 0.031). Prolonged ventilation was associated with premorbid functional status (P = 0.043) and ventilator dependence (P = 0.007) before surgery. Conclusions Cerebellar hemorrhage is associated with significant risk of mortality and ventilator dependence. In patients who require surgery, 30-day mortality risk remains high (26.6{\%}), with functional status and American Society of Anesthesiologists class predictive of death.",
author = "Gregory Arnone and Esfahani, {Darian R.} and Matt Wonais and Prateek Kumar and Scheer, {Justin K.} and Ali Alaraj and Sepideh Amin-Hanjani and Charbel, {Fady T.} and Mehta, {Ankit I.}",
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Surgery for Cerebellar Hemorrhage : A National Surgical Quality Improvement Program Database Analysis of Patient Outcomes and Factors Associated with 30-Day Mortality and Prolonged Ventilation. / Arnone, Gregory; Esfahani, Darian R.; Wonais, Matt; Kumar, Prateek; Scheer, Justin K.; Alaraj, Ali; Amin-Hanjani, Sepideh; Charbel, Fady T.; Mehta, Ankit I.

In: World neurosurgery, Vol. 106, 01.10.2017, p. 543-550.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Surgery for Cerebellar Hemorrhage

T2 - A National Surgical Quality Improvement Program Database Analysis of Patient Outcomes and Factors Associated with 30-Day Mortality and Prolonged Ventilation

AU - Arnone, Gregory

AU - Esfahani, Darian R.

AU - Wonais, Matt

AU - Kumar, Prateek

AU - Scheer, Justin K.

AU - Alaraj, Ali

AU - Amin-Hanjani, Sepideh

AU - Charbel, Fady T.

AU - Mehta, Ankit I.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objective Primary cerebellar hemorrhage accounts for 10% of all intracranial hemorrhages. Given the confined space of the posterior fossa, cerebellar hemorrhage management sometimes necessitates suboccipital decompression and hematoma evacuation. In this study, we examine outcomes after surgery for primary cerebellar hemorrhage and identify risk factors associated with adverse outcomes. Methods A retrospective review of the 2005–2014 American College of Surgeons-National Surgical Quality Improvement Program database was performed, with Current Procedural Terminology 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 A total of 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), American Society of Anesthesiologists class (P = 0.010), and history of congestive heart failure (P = 0.031). Prolonged ventilation was associated with premorbid functional status (P = 0.043) and ventilator dependence (P = 0.007) before surgery. Conclusions Cerebellar hemorrhage is associated with significant risk of mortality and ventilator dependence. In patients who require surgery, 30-day mortality risk remains high (26.6%), with functional status and American Society of Anesthesiologists class predictive of death.

AB - Objective Primary cerebellar hemorrhage accounts for 10% of all intracranial hemorrhages. Given the confined space of the posterior fossa, cerebellar hemorrhage management sometimes necessitates suboccipital decompression and hematoma evacuation. In this study, we examine outcomes after surgery for primary cerebellar hemorrhage and identify risk factors associated with adverse outcomes. Methods A retrospective review of the 2005–2014 American College of Surgeons-National Surgical Quality Improvement Program database was performed, with Current Procedural Terminology 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 A total of 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), American Society of Anesthesiologists class (P = 0.010), and history of congestive heart failure (P = 0.031). Prolonged ventilation was associated with premorbid functional status (P = 0.043) and ventilator dependence (P = 0.007) before surgery. Conclusions Cerebellar hemorrhage is associated with significant risk of mortality and ventilator dependence. In patients who require surgery, 30-day mortality risk remains high (26.6%), with functional status and American Society of Anesthesiologists class predictive of death.

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