Predictors of 30-day perioperative morbidity and mortality of unruptured intracranial aneurysm surgery

• A total of 662 patients received surgical clipping for an unruptured aneurysm.
• Operative time and chronic steroid use were associated with increased mortality.
• Operative time, age and ASA Class 2 and 3 were associated with adverse discharge.
• Operative time, age, diabetes and dependency were predictors of major complication.
• Results may aid in recognizing patients at greater risk for postop complications.

IntroductionLarge-scale studies examining the incidence and predictors of perioperative complications after surgical clipping of unruptured intracranial aneurysms (UIA) using nationally representative prospectively collected data are lacking in the literature.MethodsUsing the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) dataset, we conducted a retrospective analysis of the complications experienced by patients that underwent surgical management of a UIA between the years of 2007 and 2013. The primary outcomes of interest were mortality within the 30-day perioperative period and adverse discharge disposition to a location other than home. Predictors of morbidity and mortality were elucidated using multivariable logistic regression analyses controlling for available patient demographic, comorbidity, and operative characteristics.Results662 patients were identified in the ACS-NSQIP dataset for operative management of an unruptured aneurysm. The observed rates of 30-day mortality and adverse discharge disposition were 2.27% and 19.47%, respectively. A hundred and eight (16.31%) patients developed at least one major complication. On multivariable analysis, death within 30 days was significantly associated with increased operative time (OR 1.005 per minute, 95% CI 1.002–1.008) and chronic preoperative corticosteroid use (OR 28.4, 95% CI 1.68–480.42), whereas major complication development was associated with increased operative time (OR 1.004 per minute, 95% CI 1.002–1.006), age (OR 1.017 per year, 95% CI 1–1.034), preoperative dependency (OR 3.3, 95% CI 1.16–9.40) and diabetes mellitus (OR 2.89, 95% CI 1.45–5.75). Lastly, increasing age (OR 1.017 per year, 95% CI 1–1.034) as well as ASA Class 3 (OR 1.73, 95% CI 1.08–2.77) and 4 (OR 2.28, 95% CI 1.1–4.72) were independent predictors of discharge to a location other than home.ConclusionOur study yields morbidity and mortality benchmarks for UIA surgery in a representative, national surgical registry. It will hopefully aid in recognizing those patients at greater risk for postoperative complications following surgical management, leading to appropriate changes in treatment strategies for this selected group of patients.