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Li T, Zhang Y, Cheng X, Jia L, Tian Y, He J, He M, Chen L, Hao P, Xiao Y, Peng L, Chong W, Hai Y, You C, Fang F. Association between postoperative changes in natremia and outcomes in patients undergoing elective craniotomy. Neurosurg Rev 2024; 47:69. [PMID: 38270672 DOI: 10.1007/s10143-024-02287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
Postoperative dysnatremias, characterized by imbalances in serum sodium levels, have been linked to increased resource utilization and mortality in surgical and intensive care patients. The management of dysnatremias may involve medical interventions based on changes in sodium levels. In this study, we aimed to investigate the impact of postoperative changes in natremia on outcomes specifically in patients undergoing craniotomy.We conducted a retrospective analysis of patient records from the Department of Neurosurgery at West China Hospital, Sichuan University, covering the period from January 2011 to March 2021. We compared the highest and lowest sodium values in the first 14 postoperative days with the baseline values to define four categories for analysis: no change < 5 mmol/L; decrease > 5 mmol/L; increase > 5 mmol/L; both increase and decrease > 5 mmol/L. The primary outcome measure was 30-day mortality.A total of 12,713 patients were included in the study, and the overall postoperative mortality rate at 30 days was 2.1% (264 patients). The increase in sodium levels carried a particularly high risk, with a tenfold increase (OR 10.21; 95% CI 7.25-14.39) compared to patients with minimal or no change. Decreases in sodium levels were associated with an increase in mortality (OR 1.60; 95% CI 1.11-2.23).Moreover, the study revealed that postoperative sodium decrease was correlated with various complications, such as deep venous thrombosis, pneumonia, intracranial infection, urinary infection, seizures, myocardial infarction, and prolonged hospital length of stay. On the other hand, postoperative sodium increases were associated with acute kidney injury, deep venous thrombosis, pneumonia, intracranial infection, urinary infection, surgical site infection, seizures, myocardial infarction, and prolonged hospital length of stay.Changes in postoperative sodium levels were associated with increased complications, prolonged length of hospital stay, and 30-day mortality. Moreover, the severity of sodium change values correlated with higher mortality rates.
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Affiliation(s)
- Tiangui Li
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Department of Neurosurgery, The First People's Hospital of Longquanyi District Chengdu, Sichuan, China
| | - Yu Zhang
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lu Jia
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yixing Tian
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Jialing He
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Miao He
- Department of Anesthesia, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Lvlin Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Pengfei Hao
- Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Liyuan Peng
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Fuentes AM, Chiu RG, Nie J, Mehta AI. Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I. Clin Neurol Neurosurg 2021; 207:106757. [PMID: 34230005 DOI: 10.1016/j.clineuro.2021.106757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Chiari malformation type 1 (CM-1) is a congenital neurologic condition in which the cerebellar tonsils herniate below the foramen magnum, resulting in symptoms such as headache and neck pain. Two common surgical treatment approaches are posterior fossa decompression with (PFDD) and without duraplasty (PFD). Previous single-center studies have demonstrated increased neurologic complications after PFDD compared to PFD. The goal of this study is to determine differences in inpatient complications and hospitalization data among patients treated with these surgical techniques using a nationwide sample. METHODS The National Inpatient Sample (NIS) was queried for years 2012-2015 for all patients with a primary diagnosis of CM-1 who underwent PFD or PFDD. Differences in baseline demographics and comorbidities were accounted for in subsequent analysis using propensity score matching. Hospitalization measures and inpatient complications of the two cohorts were compared using Chi-squared tests and t-tests when appropriate. RESULTS A total of 2395 patients with CM-1 were included in this study, with 750 (31.3%) undergoing PFD and 1645 (68.7%) undergoing PFDD. PFDD was associated with higher total hospital costs than PFD. There were no significant differences in other hospitalization or discharge data, non-neurologic complications, or CNS complications (CSF leak, pseudomeningocele, abscess, meningitis, stroke) between the two surgical groups. CONCLUSIONS This study represents the largest national analysis to date of adult CM-1 patients undergoing PFD or PFDD. Our findings suggest that whether the decision is made to perform the less invasive PFD or more invasive PFDD, inpatient complications and hospitalization data will not significantly differ.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - James Nie
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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