Neurosurgery Morbidity and Mortality: A Prospective Surgical and Medical Analysis.

Abstract

Objective: The analysis of morbidity and mortality is fundamental for improving the quality of patient care. The objective of this study was to evaluate the combined medical and surgical morbidity and mortality of neurosurgical patients.

Methods: We performed a daily prospective compilation of morbidities and mortalities during a consecutive 4-month period in all the patients who were 18 years of age or older and had been admitted to the neurosurgery service at the Puerto Rico Medical Center. For each patient, any surgical or medical complication, adverse event, or death within 30 days was included. The patients' comorbidities were analyzed for their influence on mortality.

Results: Fifty-seven percent of the patients presented at least 1 complication. The most frequent complications were hypertensive episodes, mechanical ventilation for more than 48 hours, sodium disturbances, and bronchopneumonia. Twenty-one patients died, for an overall 30-day mortality of 8.2%. Mechanical ventilation for more than 48 hours, sodium disturbances, bronchopneumonia, unplanned intubation, acute kidney injury, blood transfusion, shock, urinary tract infection, cardiac arrest, arrhythmia, bacteremia, ventriculitis, sepsis, elevated intracranial pressure, vasospasm, stroke, and hydrocephalus were significant factors for mortality. None of the analyzed patients' comorbidities were significant for mortality or longer length of stay. The type of surgical procedure did not influence the length of stay.

Conclusion: The mortality and morbidity analysis provided valuable neurosurgical information that may influence future treatment management and corrective recommendations. Indication and judgment errors were significantly associated with mortality. In our study, the patients' comorbidities were not significant for mortality or increased length of stay.