Using the Postoperative Morbidity Survey to Measure Morbidity After Cranial Neurosurgery.
Journal
Journal of neurosurgical anesthesiology
ISSN: 1537-1921
Titre abrégé: J Neurosurg Anesthesiol
Pays: United States
ID NLM: 8910749
Informations de publication
Date de publication:
01 Apr 2022
01 Apr 2022
Historique:
received:
22
09
2020
accepted:
14
12
2020
entrez:
7
3
2022
pubmed:
8
3
2022
medline:
11
3
2022
Statut:
ppublish
Résumé
The incidence of morbidity after cranial neurosurgery is significant, reported in up to a quarter of patients depending on methodology used. The Postoperative Morbidity Survey (POMS) is a reliable method for identifying clinically relevant postsurgical morbidity using 9 organ system domains. The primary aim of this study was to quantify early morbidity after cranial neurosurgery using POMS. The secondary aims were to identify non-POMS-defined morbidity and association of POMS with postoperative hospital length of stay (LOS). A retrospective electronic health care record review was conducted for all patients who underwent elective or expedited major cranial surgery over a 3-month period. Postsurgical morbidity was quantified on postoperative days (D) 1, 3, 5, 8, and 15 using POMS. A Poisson regression model was used to test the correlation between LOS and total POMS scores on D1, 3 and 5. A further regression model was used to test the association of LOS with specific POMS domains. A total of 246 patients were included. POMS-defined morbidity was 40%, 30%, and 33% on D1, D3, and D8, respectively. The presence of POMS morbidity on these days was associated with longer median (range) LOS: D1 6 (1 to 49) versus 4 (2 to 45) days; D3 8 (4 to 89) versus 6 (4 to 35) days; D5 14 (5 to 49) versus 8.5 (6 to 32) days; D8 18 (9 to 49) versus 12.5 (9 to 32) days (P<0.05). Total POMS score correlated with overall LOS on D1 (P<0.001), D3 (P<0.001), and D5 (P<0.001). A positive response to the "infectious" (D1, 3), "pulmonary" (D1), and "renal" POMS items (D1) were associated with longer LOS. Although our data suggests that POMS is a useful tool for measuring morbidity after cranial neurosurgery, some important morbidity items that impact on LOS are missed. A neurosurgery specific tool would be of value.
Sections du résumé
BACKGROUND
BACKGROUND
The incidence of morbidity after cranial neurosurgery is significant, reported in up to a quarter of patients depending on methodology used. The Postoperative Morbidity Survey (POMS) is a reliable method for identifying clinically relevant postsurgical morbidity using 9 organ system domains. The primary aim of this study was to quantify early morbidity after cranial neurosurgery using POMS. The secondary aims were to identify non-POMS-defined morbidity and association of POMS with postoperative hospital length of stay (LOS).
MATERIALS AND METHODS
METHODS
A retrospective electronic health care record review was conducted for all patients who underwent elective or expedited major cranial surgery over a 3-month period. Postsurgical morbidity was quantified on postoperative days (D) 1, 3, 5, 8, and 15 using POMS. A Poisson regression model was used to test the correlation between LOS and total POMS scores on D1, 3 and 5. A further regression model was used to test the association of LOS with specific POMS domains.
RESULTS
RESULTS
A total of 246 patients were included. POMS-defined morbidity was 40%, 30%, and 33% on D1, D3, and D8, respectively. The presence of POMS morbidity on these days was associated with longer median (range) LOS: D1 6 (1 to 49) versus 4 (2 to 45) days; D3 8 (4 to 89) versus 6 (4 to 35) days; D5 14 (5 to 49) versus 8.5 (6 to 32) days; D8 18 (9 to 49) versus 12.5 (9 to 32) days (P<0.05). Total POMS score correlated with overall LOS on D1 (P<0.001), D3 (P<0.001), and D5 (P<0.001). A positive response to the "infectious" (D1, 3), "pulmonary" (D1), and "renal" POMS items (D1) were associated with longer LOS.
CONCLUSION
CONCLUSIONS
Although our data suggests that POMS is a useful tool for measuring morbidity after cranial neurosurgery, some important morbidity items that impact on LOS are missed. A neurosurgery specific tool would be of value.
Identifiants
pubmed: 35255015
doi: 10.1097/ANA.0000000000000756
pii: 00008506-202204000-00008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
201-208Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
L.D. is supported by an NIHR Academic Clinical Fellowship and was the recipient of a research fellowship sponsored by B. Braun. A.K.T. research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. M.S. is Editor-in-Chief of the Journal of Neurosurgical Anesthesiology: this manuscript was handled by Dr. Alana Flexman, Associate Editor. The remaining authors have no conflicts of interest to disclose
Références
Gozal YM, Akture E, Ravindra VM, et al. Defining a new neurosurgical complication classification: lessons learned from a monthly Morbidity and Mortality Conference. J Neurosurg. 2020;132:272–276 10.3171/2018.9.JNS181004
doi: 10.3171/2018.9.JNS181004
Schiavolin S, Broggi M, Acerbi F, et al. The impact of neurosurgical complications on patients’ health status: a comparison between different grades of complications. World Neurosurg. 2015;84:36–40 10.1016/j.wneu.2015.02.008
doi: 10.1016/j.wneu.2015.02.008
Rolston JD, Han SJ, Lau CY, et al. Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011. J Neurosurg. 2014;120:736–745 10.3171/2013.10.JNS122419
doi: 10.3171/2013.10.JNS122419
Rock AK, Opalak CF, Workman KG, et al. Safety outcomes following spine and cranial neurosurgery: evidence from the national surgical quality improvement program. J Neurosurgl Anesthesiol. 2018;30:328–336 10.1097/ANA.0000000000000474
doi: 10.1097/ANA.0000000000000474
Alexandre V, Guyonaud C, Frasca D, et al. Major complications after scheduled craniotomy: a justification for systematic postoperative intensive care admission? Eur J Anaesthesiol. 2020;37:147–149 10.1097/EJA.0000000000001045
doi: 10.1097/EJA.0000000000001045
Viken HH, Iversen IA, Jakola A, et al. When are complications after brain tumour surgery detected? World Neurosurg. 2018;112:e702–e710 10.1016/j.wneu.2018.01.137
doi: 10.1016/j.wneu.2018.01.137
Reponen E, Tuominen H, Korja M. Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs: case neurosurgery. Neurosurgery. 2019;85:500–507 10.1093/neuros/nyy380
doi: 10.1093/neuros/nyy380
Dindo D, Demartines N, Clavien P. Classification of surgical complications: a new proposal with evaluation in a Cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213 10.1097/01.sla.0000133083.54934.ae
doi: 10.1097/01.sla.0000133083.54934.ae
Patel ABU, Reyes A, Ackland GL. Non-inferiority of retrospective data collection for assessing perioperative morbidity. Peer J. 2015;3:e1466 10.7717/peerj.1466
doi: 10.7717/peerj.1466
Bennett-Guerrero E, Welsby I, Dunn TJ, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg. 1999;89:514–519 10.1097/00000539-199908000-00050
doi: 10.1097/00000539-199908000-00050
Grocott MPW, Browne JP, Van der Meulen J, et al. The post-operative morbidity survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol. 2007;60:919–928 10.1016/j.jclinepi.2006.12.003
doi: 10.1016/j.jclinepi.2006.12.003
Sanders J, Keogh BE, Van der Meulen J, et al. The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery. J Clin Epidemiol. 2012;65:423–433 10.1016/j.jclinepi.2011.11.004
doi: 10.1016/j.jclinepi.2011.11.004
Marufu TC, Elphick HL, Ahmed FB, et al. Short-term morbidity factors associated with length of hospital stay (LOS): development and validation of a Hip Fracture specific postoperative morbidity survey (HF-POMS). Injury. 2019;50:931–938 10.1016/j.injury.2019.03.009
doi: 10.1016/j.injury.2019.03.009
Stubbs DJ, Bowen JL, Furness RC, et al. Development and validation of an electronic postoperative morbidity score. Anesth Analg. 2019;129:935–942 10.1213/ANE.0000000000003953
doi: 10.1213/ANE.0000000000003953
D’Antona L, Blamey SC, Craven CL, et al. Early postoperative outcomes of normal pressure hydrocephalus: results of a service evaluation. J Neurosurg Anesthesiol. 2019. [Epub ahead of print] 10.1097/ANA.0000000000000668
doi: 10.1097/ANA.0000000000000668
Stubbs DJ, Davies BM, Bashford T, et al. Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study. BMJ Open. 2020;10:e037385 10.1136/bmjopen-2020-037385
doi: 10.1136/bmjopen-2020-037385
Perioperative Quality Improvement Programme. Available at: https://pqip.org.uk/content/home . Accessed December 12, 2020.
National Confidential Enquiry into Patient Outcome and Death. 2004. Available at: https://www.ncepod.org.uk/classification.html . Accessed December 12, 2020.
AXA PPP schedule of procedures. 2020. Available at: https://provider.axappphealthcare.co.uk/schedule-of-procedures-and-fees/ . Accessed December 12, 2020.
Protopapa KL, Simpson JC, Smith NCE, et al. Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg. 2014;101:1774–1783 10.1002/bjs.9638
doi: 10.1002/bjs.9638
Davies J, Whitlock J, Gutmanis I, et al. Inter-rater reliability of the retrospectively assigned clinical frailty scale score in a geriatric outreach population. Can Geriatr J. 2018;21:1–5 10.5770/cgj.21.263
doi: 10.5770/cgj.21.263
Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia. 2017;72:233–247 10.1111/anae.13773
doi: 10.1111/anae.13773
KDIGO Acute Kidney Injury definition and guidelines. 2012. Available at: https://kdigo.org/guidelines/acute-kidney-injury/ . Accessed December 12, 2020.
The Society of British Neurological Surgeons National Audit Programme. 2013. Available at: https://www.sbns.org.uk/index.php/audit/ . Accessed December 12, 2020.