Morbimortalidad asociada al Departamento de Neurocirugía del Hospital de Clínicas: Estudio longitudinal retrospectivo durante abril 2017-abril 2019

Gonzalo Bertullo; Rodrigo Moragues; Laura Lanning; Víctor Reyes; Agustín Oliveira; Cristian Cardozo; Rodrigo Veiga; Patricia Álvarez

doi:10.29193/RMU.37.3.4

Authors

Gonzalo Bertullo Universidad de la República, Facultad de Medicina, Hospital de Clínicas, 1Dpto. Neurocirugía, Asistente. Neurocirujano
Rodrigo Moragues Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Dpto. Neurocirugía, Prof. Adj. Neurocirujano
Laura Lanning Universidad de la República, Facultad de Medicina, Estudiante
Víctor Reyes Universidad de la República, Facultad de Medicina, Estudiante
Agustín Oliveira Universidad de la República, Facultad de Medicina, Estudiante
Cristian Cardozo Universidad de la República, Facultad de Medicina, Estudiante
Rodrigo Veiga Universidad de la República, Facultad de Medicina, Estudiante
Patricia Álvarez Universidad de la República, Facultad de Medicina, Estudiante

DOI:

https://doi.org/10.29193/RMU.37.3.4

Keywords:

MORBIDITY AND MORTALITY, NEUROSURGERY, UNIVERSITY HOSPITALS, URUGUAY

Abstract

Introduction: morbidity and mortality rates allow for the evaluation of the quality of care and outcome and they also make it possible to compare different healthcare centers. This is the first morbidity and mortality study in neurosurgery carried out in Uruguay.
Objective: to determine the global and specific morbidity and mortality rates in the Neurosurgery Department at the Clínicas University Hospital, and to determine if mortality and morbidity are associated to surgical complications.
Method: retrospective, longitudinal, observational and descriptive analysis of all patients >15 years old that underwent a neurosurgical procedure between April 2017 and 2019. Data were obtained from patient medical records. The following variables were analyzed: age, sex, comorbidity, clinical data, diagnosis, opportunity of surgical procedure, complications, type of complication, mortality, cause of mortality, outcome and surgical time.
Results: 477 patients underwent neurosurgical procedure, 72 of which were complicated surgeries. Overall mortality was 5.5% (26/477) and morbidity 15% (72/477). 36% of complicated patients died (26/72). Vascular pathology was the specific morbidity that complicated patients the most 20% (14/69). Infection was the most frequent type of complication 46% (39/84). The evolution of the disease itself and the terrain caused the death of 90% of complicated patients undergoing emergency surgery (19/21), being the latter an independent risk factor for death (p = 0.018).
As to coordinated surgeries, the cause of death was associated to the surgical act (80%). Association was found between vascular pathology and morbidity and mortality (p = 0.015) and between ischemic complication and morbidity and mortality (p = 0.024). The presence of intracranial hypertension (IH) was associated with a bad outcome (p= 0.003).
Conclusions: the results show a good quality of care compared to other centers. There are still aspects to correct to reduce morbidity and mortality rates.

References

1) Lassen B, Helseth E, Rønning P, Scheie D, Johannesen TB, Mæhlen J, et al. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 2011; 68(5):1259–68.
2) Hammers R, Anzalone S, Sinacore J, Origitano T. Neurosurgical mortality rates: what variables affect mortality within a single institution and within a national database? J Neurosurg 2010; 112(2):257–64.
3) Campbell E, Beez T, Todd L. Prospective review of 30–day morbidity and mortality in a paediatric neurosurgical unit. Childs Nerv Syst 2017; 33(3):483–9.
4) Saver JL, Filip B, Hamilton S, Yanes A, Craig S, Cho M, et al. Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA). Stroke 2010; 41(5):992–5.
5) Bydon M, Abt N, De la Garza–Ramos R, Macki M, Witham T, Gokaslan Z, et al. Impact of resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients. J Neurosurg 2015; 122(4):955–61.
6) Fuller AT. Neurosurgical outcomes following establishment of a twinning program at Mulago Hospital in Uganda [Tesis de Maestría]. Durham: Global Health Institute in the Graduate School of Duke University, 2015.
7) Theodosopoulos PV, Ringer AJ, McPherson CM, Warnick RE, Kuntz C 4th, Zuccarello M, et al. Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures. J Neurosurg 2012; 117(5):947–54.
8) Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40:994–1025.
9) Broggi M, Zattra C, Ferroli P. How to compare outcomes and complications in neurosurgery: we must make the mission possible! Surg Neurol Int 2018; 9(1):65.
10) Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991; 324(6):370–6.
11) Bonsanto MM, Hamer J, Tronnier V, Kunze S. A complication conference for internal quality control at the Neurosurgical Department of the University of Heidelberg. Acta Neurochir Suppl 2001; 78:139–45.
12) Houkin K, Baba T, Minamida Y, Nonaka T, Koyanagi I, Iiboshi S. Quantitative analysis of adverse events in neurosurgery. Neurosurgery 2009; 65(3):587–94.
13) Kashiwazaki D, Saito H, Uchino H, Akioka N, Hori E, Shibata T, et al. Morbidity and mortality conference can reduce avoidable morbidity in neurosurgery: its educational effect on residents and surgical safety outcomes. World Neurosurg 2020; 133:e348–e355.