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Is duration of surgery a risk factor for extracranial complications and surgical site infections after intracranial tumor operations?

  • Clinical Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Duration of surgery has not been much explored as a possible risk factor for complications in neurosurgery.

Objective

To explore the possible impact of duration of surgery on the risk of developing extracranial complications and surgical site infections following intracranial tumor surgery.

Methods

Retrospective review of 1,000 consecutive patients who underwent planned surgery for intracranial tumors at a single institution. Complications within 30 days of surgery were registered.

Results

Of all patients, 18.6 % acquired extracranial complications, and they were seen in 14.3, 17.7, 22.1 and 37.4 % after operations lasting <2, 2–4, 4–6 and ≥6 h (p = 0.025). In multivariate analyses, duration of surgery per hour [OR 1.14 (1.04–1.25)], ASA 3–4 [OR 1.37 (1.14–1.63)] and acquired neurological deficits [OR 1.47 (1.02–2.11)] were associated with extracranial complications. For surgical site infections, there was a significant association between increased risk and increased duration of surgery (p < 0.001).

Conclusion

Duration of surgery together with comorbidity and acquired neurological deficits is an independent risk factor for extracranial complications after brain tumor surgery. Duration of surgery is also associated with surgical site infections. Knowledge about the potential harm of slow surgery should be of interest to neurosurgeons when deciding on various surgical approaches, surgical tools or providing training. Also if acquiring ethical approval or informed consent in technical research projects, the risks associated with prolonging brain surgery should be considered. Special consideration should be warranted in patients with significant comorbidity, planned long surgery and higher risk of acquiring neurological deficits after surgery.

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Abbreviations

ASA :

American Society of Anesthesiologists

CCI :

Charlson Comorbidity Index

CNS :

Central nervous system

CSF :

Cerebrospinal fluid

DVT :

Deep vein thrombosis

ICU :

Intensive care unit

LWMH :

Low-weight molecular heparin

OR :

Operating room/odds ratio

PE :

Pulmonary embolism

SCD :

Sequential gradient pneumatic leg compression

SSI :

Surgical site infection

UTI :

Urinary tract infection

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Acknowledgments

We would like to thank research assistants Lisa Millgård Sagberg and Lina Mohrsen Nordtvedt for helping with data extraction from medical records.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Faculty of Medicine, Norwegian University of Science and Technology, DMF, NTNU, P.O. Box 8905, 7491, Trondheim, Norway

    Arthur Golebiowski

  2. Department of Anesthesia, St. Olav’s University Hospital, P.O. Box 3250, 7006, Trondheim, Norway

    Christina Drewes

  3. Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, P.O. Box 8905, 7491, Trondheim, Norway

    Christina Drewes

  4. Department of Neurosurgery, St. Olav’s University Hospital, Olav Kyrres gate 17, 7006, Trondheim, Norway

    Sasha Gulati, Asgeir Store Jakola & Ole Solheim

  5. National Competence Centre for Ultrasound and Image-guided Therapy, St. Olav’s University Hospital, 7006, Trondheim, Norway

    Asgeir Store Jakola & Ole Solheim

  6. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Ole Solheim

Authors
  1. Arthur Golebiowski
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  2. Christina Drewes
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  3. Sasha Gulati
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  4. Asgeir Store Jakola
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  5. Ole Solheim
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Corresponding author

Correspondence to Arthur Golebiowski.

Additional information

Comment

Surgical duration has been an issue in neurosurgery ever since Victor Horsley shocked Harvey Cushing in July 1900, when he anaesthetised a patient and removed the trigeminal ganglion via a sub temporal craniotomy in under an hour. Cushing wrote in his diary that there was nothing of modern neurological surgery that could be learnt from Horsley. Paul Bucy, who saw him operate, said that Cushing was a 'tedious surgeon'. Yet it was the slow and steady Cushing tradition that has dominated world neurosurgery for a century. Having trained under one of the most famous vascular neurosurgeons of his generation, who would elegantly and effortlessly clip an aneurysm in under an hour, and having been influenced from an early stage by fast trans sphenoidal experts, I am delighted to see a scientific study supporting surgical speed.

Michael Powell

London,UK

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Golebiowski, A., Drewes, C., Gulati, S. et al. Is duration of surgery a risk factor for extracranial complications and surgical site infections after intracranial tumor operations?. Acta Neurochir 157, 235–240 (2015). https://doi.org/10.1007/s00701-014-2286-3

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  • DOI: https://doi.org/10.1007/s00701-014-2286-3

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