Postoperative complications in elective and non-elective neurosurgery

One hundred and twenty seven patients were included in elective surgery group and 75 patients in non-elective surgery group. The elective group had more vomiting (p=0.010) and pain (p<0.001) and the non-elective group presented more intracranial hypertension (p=0.001), anisocoria (p=0.002), cerebral vasospasm (p=0.043), light-unresponsive pupil (p=0.006) and reoperation (p=0.046). The mortality rate was 5.5% in the elective surgery group and 26.7% in the non-elective surgery group (p<0.001).

Conclusion

Elective procedures in neurosurgery are related to higher frequencies of systemic complications while non-elective surgeries had significantly higher rates of neurological complications and mortality.

Neurosurgical procedures; Postoperative complications; Perioperative nursing

Characteristics	Elective (n=127)	Non-elective (n=75)	p-value	RR (CI95%)
Characteristics	n (%)	n (%)	p-value	RR (CI95%)
Neurological
Intracranial hypertension	1(0.8)	8(10.7)	0.013†	0.07(0.01-0.57)
Intraparenchymal hemorrhage	3(2.4)	2(2.7)	0.893^†	0.88(0.15-5.18)
Pneumocephalus	16(12.6)	3(4.0)	0.061^†	3.15(0.94-10.45)
Periorbital hematoma	18(14.2)	11(14.7)	0.923*	0.97(0.48-1.93)
Anisocoria	5(4.7)	14(18.7)	0.002*	0.21(0.08-0.56)
Cardiovascular
Arterial hypotension	16(12.6)	15(20.0)	0.160*	0.630(0.33-1.19)
Arterial hypertension	44(34.6)	26(34.7)	0.998*	0.99(0.67-1.47)
Vasoactive drugs	24(18.9)	30(40.0)	0.001*	0.47(0.30-0.74)
Sinus bradycardia	18(14.2)	12(16.0)	0.724*	0.88(0.45-1.73)
Sinus tachycardia	45(35.4)	29(38.7)	0.643*	0.91(0.63-1.32)
Gastrointestinal
Vomiting	23(18.1)	1(1.3)	0.010^†	13.58(1.87-98.5)
Metabolic
Potassium disorders	4(3.1)	9(12.0)	0.022^†	0.26(0.08-0.82)
Hyperglycemia	86(67.7)	43(57.3)	0.155*	1.18(0.93-1.48)
Intensive insulin therapy	3(2.4)	2(2.7)	0.890^†	0.88(0.15-5.18)
Hyperthermia	26(20.5)	26(34.7)	0.026*	0.59(0.37-0.93)
Hypothermia	19(15.0)	18(24.0)	0.109*	0.62(0.35-1.11)
Headache	33(26.0)	5(6.7)	0.003*	3.89(1.59-9.55)

Characteristics	Elective (n=127)	Non-elective (n=75)	p-value	RR (CI95%)
Characteristics	n (%)	n (%)	p-value	RR (CI95%)
Neurological
Intracranial hypertension	14(11.0)	37(49.6)	0.001*	0.22(0.13-0.38)
Intraparenchymal hemorrhage	7(5.5)	5(6.7)	0.735^†	0.83(0.27-2.51)
Intraventricular hemorrhage	2(1.6)	5(6.7)	0.080^†	0.23(0.04-1.18)
Vasoespasm	2(1.6)	6(8.0)	0.043^†	0.19(0.04-0.41)
Focal seizures	4(3.4)	1(1.3)	0.438^†	2.36(0.26-20.4)
Generalized seizures	3(3.4)	2(2.7)	0.893^†	0.88(0.15-5.18)
Hydrocephalus	1(0.8)	2(2.7)	0.316^†	0.30(0.27-3.20)
CSF leak	5(3.9)	4(5.3)	0.643*	0.73(0.20-2.66)
Periorbital edema	40(31.4)	24(32.5)	0.941*	0.98(0.64-1.49)
Periorbital hematoma	31(24.4)	19(25.3)	0.883*	0.96(0.58-1.54)
Light-unresponsive pupil	6(4.7)	13(17.3)	0.006*	0.27(0.08-0.68)
Aphasia	5(3.9)	3(4.0)	0.482^†	0.98(0.24-4.00)
Reoperation	10(7.9)	13(17.3)	0.046*	0.45(0.21-0.98)
Cardiovascular
Arterial hypotension	26(20.5)	35(46.7)	0.001*	0.43(0.28-0.66)
Arterial hypertension	94(74.0)	63(84.0)	0.082*	0.88(0.76-1.01)
Vasoactive drug	31(24.4)	46(61.3)	<0.001*	0.40(0.28-0.57)
Arrhythmia	2(1.6)	5(6.7)	0.080^†	0.23(0.04-1.18)
Sinus bradycardia	33(26.0)	36(69.3)	0.001*	0.54(0.37-0.79)
Sinus tachycardia	75(59.1)	55(73.3)	0.033*	0.81(0.66-0.98)
Cardiac arrest	6(4.7)	20(26.7)	0.001*	0.18(0.07-0.42)
Venous thromboembolism	1(0.8)	1(1.3)	0.708^†	0.59(0.04-9.30)
Pulmonary embolism	1(0.8)	2(2.7)	0.316^†	0.30(0.03-3.20)
Gastrointestinal
Nausea	25(19.7)	10(13.3)	0.258*	1.48(0.75-2.90)
Vomiting	35(27.6)	25(33.3)	0.382*	0.83(0.54-1.27)
Gastroesophageal reflux	4(3.1)	14(18.7)	0.001^†	0.17(0.06-0.49)
Renal
Acute kidney injury	2(1.6)	8(10.7)	0.014^†	0.15(0.03-0.68)
Urinary retention	13(10.2)	13(17.3)	0.148*	0.59(0.29-1.21)
Metabolic
Potassium disorders	29(22.8)	38(50.7)	0.001*	0.45(0.31-0.67)
Calcium disorders	33(26.0)	33(44.0)	0.008*	0.59(0.40-0.87)
Sodium disorders	42(33.1)	44(58.7)	0.001*	0.56(0.41-0.77)
Hypoglycemia	17(13.3)	26(34.7)	0.001*	0.39(0.23-0.66)
Hyperglycemia	86(67.7)	55(73.3)	0.390*	0.92(0.77-1.11)
Infectious
Hypothermia	64(50.4)	42(56.0)	0.435*	0.90(0.69-1.17)
Hyperthermia	65(51.2)	54(72.0)	0.002*	0.71(0.57-0.89)
Bloodstream infection	7(5.5)	6(8.0)	0.488*	0.69(0.24-1.97)
SSI	3(2.4)	4(5.3)	0.277^†	0.44(0.10-1.93)
Meningitis	2(1.6)	5(6.7)	0.080^†	0.24(0.05-1.19)
Pulmonary infection	10(7.9)	23(30.7)	<0.001*	0.26(0.13-0.51)
Urinary tract infection	6(4.7)	8(10.7)	0.117*	0.44(0.16-1.23)
Headache	83(65.4)	21(28.0)	<0.001*	1.98(1.42-2.76)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author: Ellen Maria Pires Siqueira. Napoleão de Barros street, 754, 04024-002 , São Paulo, SP, Brazil. emc.pires@yahoo.com.br