Major and minor complications in extraoperative electrocorticography: A review of a national database

• Risks of extraoperative electrocorticography (ECoG) are documented almost exclusively by case series from academic medical centers.
• The American College of Surgeons NSQIP registry contains data from a wide variety of institutions, not just academic centers.
• In NSQIP, major complications occurred in 3.4% of 177 extraoperative ECoG cases, while minor complications occurred in 9.6%.
• Complications like UTIs and DVTs are underreported in retrospective case series, yet make up a majority of minor complications in this dataset.

The risk profile of extraoperative electrocorticography (ECoG) is documented almost exclusively by case series from a limited number of academic medical centers. These studies tend to underreport minor complications, like urinary tract infections (UTIs) and deep venous thromboses (DVTs), that nevertheless affect hospital cost, length of stay, and the patient's quality of life. Herein, we used data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) to estimate the rate of adverse events in extraoperative ECoG surgeries. NSQIP is a validated dataset containing nearly 3 million procedures from over 600 North American hospitals, and uses strict criteria for the documentation of complications. Major complications occurred in 3.4% of 177 extraoperative ECoG cases, while minor complications occurred in 9.6%. The most common minor complication was bleeding requiring a transfusion in 3.4% of cases, followed by sepsis, DVT, and UTI each in 2.3% of cases. No mortality was reported. Overall, in a national database containing a heterogeneous population of hospitals, major complications of extraoperative ECoG were rare (3.4%). Complications such as UTI and DVT tend to be underreported in retrospective case series, yet make up a majority of minor complications for ECoG patients in this dataset.