Rapid response system and outcomes in patients who underwent cranial neurosurgery: a nationwide cohort study.

IF 3.5 2区医学 Q1 CLINICAL NEUROLOGY Journal of neurosurgery Pub Date : 2024-10-11 DOI:10.3171/2024.6.JNS24984

Tak Kyu Oh, In-Ae Song

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Abstract

Objective: Hospitals use rapid response systems (RRSs) to identify and treat patients whose conditions rapidly worsen after admission. However, no study has examined the effects of RRS deployment on the clinical outcomes of patients undergoing cranial neurosurgery. Thus, the authors investigated whether use of RRS affects clinical outcomes in these patients.

Methods: This nationwide, retrospective, population-based cohort study included adult patients who underwent cranial neurosurgery in South Korea between January 1, 2019, and December 31, 2021. The authors classified patients admitted to hospitals that operated RRS into the RRS group and those admitted to hospitals that did not operate RRS into the non-RRS group.

Results: Overall, 73,600 hospitalized patients who underwent cranial neurosurgery were included in this study. These patients were divided into 2 groups: 38,544 (52.4%) were included in the RRS group and 35,066 (47.6%) in the non-RRS group. After propensity score matching, 40,058 patients (20,029 in each group) remained. The in-hospital mortality rate was 10.1% (2022/20,029) for the non-RRS group and 8.9% (1792/20,029) for the RRS group. In the logistic regression analysis, the in-hospital mortality rate of the RRS group was 12% (OR 0.88, 95% CI 0.82-0.94, p < 0.001) lower than that of the non-RRS group. The 1-year all-cause mortality rate was 26.5% (5300/20,029) in the non-RRS group and 24.6% (4921/20,029) in the RRS group. In the Cox regression analysis, the 1-year all-cause mortality rate of the RRS group was 9% (HR 0.91, 95% CI 0.88-0.95; p < 0.001) lower than that of the non-RRS group.

Conclusions: This population-based cohort study revealed that implementing RRS was associated with enhanced short- and long-term survival outcomes in patients who underwent cranial neurosurgery. The authors' findings indicate that the introduction of RRS can enhance patient survival rates after cranial neurosurgery.

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快速反应系统与颅神经外科手术患者的预后：一项全国性队列研究。

目的：医院使用快速反应系统（RRS）来识别和治疗入院后病情迅速恶化的患者。然而，还没有研究表明快速反应系统的使用会对接受颅神经外科手术的患者的临床效果产生影响。因此，作者研究了使用 RRS 是否会影响这些患者的临床预后：这项基于人群的全国性回顾性队列研究纳入了 2019 年 1 月 1 日至 2021 年 12 月 31 日期间在韩国接受颅神经外科手术的成年患者。作者将在实施 RRS 的医院住院的患者分为 RRS 组，将在未实施 RRS 的医院住院的患者分为非 RRS 组：本研究共纳入了 7.36 万名接受过颅脑神经外科手术的住院患者。这些患者被分为两组：38544 人（52.4%）被纳入 RRS 组，35066 人（47.6%）被纳入非 RRS 组。经过倾向评分匹配后，剩下 40,058 名患者（每组 20,029 人）。非 RRS 组的院内死亡率为 10.1%（2022/20,029），RRS 组为 8.9%（1792/20,029）。在逻辑回归分析中，RRS 组的院内死亡率比非 RRS 组低 12% (OR 0.88, 95% CI 0.82-0.94, p < 0.001)。非 RRS 组的 1 年全因死亡率为 26.5%（5300/20,029），RRS 组为 24.6%（4921/20,029）。在 Cox 回归分析中，RRS 组的 1 年全因死亡率比非 RRS 组低 9% (HR 0.91, 95% CI 0.88-0.95; p < 0.001)：这项基于人群的队列研究显示，实施 RRS 与颅脑神经外科手术患者短期和长期生存率的提高有关。作者的研究结果表明，引入 RRS 可以提高颅神经外科手术后患者的存活率。

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来源期刊

Journal of neurosurgery 医学-临床神经学

CiteScore

7.20

自引率

7.30%

发文量

1003

审稿时长

1 months

期刊介绍： The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.