H. Hong1, R. R. Kelz2, M. J. Smith1 1University Of Pennsylvania,Neurosurgery,Philadelphia, PA, USA 2University Of Pennsylvania,Surgery,Philadelphia, PA, USA
Introduction: The role of open surgical clipping as the optimal treatment for patients with intracranial aneurysm (ICA) remains unclear. Existing studies to address this issue lack the ability to reliably adjust for disease-specific and procedure-specific variables that may significantly influence treatment outcomes. The aim of this study was to identify factors associated with postoperative death/stroke following surgical clipping for brain aneurysm.
Methods: A retrospective cohort study of patients undergoing surgical clipping for ICA repair was conducted using the multi-institutional American College of Surgeons National Quality Improvement Project (ACS NSQIP) participant use file (2006-2013). The primary outcome measure was a composite variable, 30-day death or stroke (30dDS). Patient, disease, and procedure characteristics were compared using the Chi-square test. A multivariate logistic regression model was developed to determine the factors associated with 30dDS.
Results: A total of 974 adult patients were identified for inclusion during the 8-year study period. The overall 30dDS was 12.7% with 63 deaths and 80 strokes. In the multivariate model, patients with hypertension requiring antihypertensive medication, or in a coma state prior to the operation were noted to have a significantly higher risk of 30dDS (OR=2.4, 95% CI 1.2-5.1 and OR=6.8, 95% CI 2.2-22.8 respectively).
Conclusion: Preoperative hypertension requiring antihypertensive medication and coma status are independently associated with 30dDS in patients undergoing open surgery for ICA. Hypertension and state of unconsciousness should be considered as priority risk factors in management of ICA, regardless of other medical comorbidities. These factors should be a part of the preoperative discussion when getting informed consent.