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03-11-2011 | Surgery | Article

Men at high complication risk after neurosurgery


Free abstract

MedWire News: Men are more likely than women to have complications after neurosurgical intervention, report researchers.

Despite the inherent limitations of a retrospective analysis, "we feel our findings yield important insight with regard to the relation between gender and post-operative outcomes," say Abdulrahman El-Sayed (Columbia University, New York, USA) and team.

In all, complications arose in 15.8% of 918 patients within 30 days of undergoing neurosurgical intervention at a University of Michigan hospital. Complications included death, coma lasting more than 24 hours, acute renal failure, unplanned intubation, pneumonia, cardiac arrest, pulmonary embolus, sepsis, seizure, and cerebrovascular accident.

Men had almost twice the complication rate of women, at 20.3% versus 11.3%, the team reports in the journal Neurosurgery. Also, craniotomy patients had more complications than those undergoing spinal surgery, at 18.6% versus 10.8%, and complications were much more frequent in patients with coronary heart disease than in those without, at 37.8% versus 13.7%.

These differences persisted on multivariate analysis, with patients 2.0-fold more likely to have complications if they were male, 2.2-fold more likely if they underwent craniotomy rather than spinal surgery, and 3.2-fold more likely if they had coronary heart disease.

The underlying reasons for the gender differences are "likely to be complex and multifactorial," say the researchers, adding that sex hormones and gender differences in social support and cardiovascular disease may contribute.

Men had significantly longer hospital stays than women, at 7.5 versus 5.7 days, and any patient who had a complication had an increased length of stay, at 15.4 versus 5.0 days for those who did not. Craniotomy patients and those with coronary heart disease also had long stays in hospital.

On multivariate analysis, male gender, craniotomy, and coronary heart disease remained associated with increased length of hospital stay, and craniotomy was also associated with increased length of stay in the intensive care unit.

"These findings should be considered when advising patients about the risks of neurosurgical intervention," say El-Sayed et al.

"As the incidence of post-operative complications in neurosurgery is relatively high, it is crucial to improve clinicians' abilities to predict post-operative complications based on pre- and peri-operative factors, and to most adequately prepare for and prevent them."

They conclude: "More research is needed about the influence of gender on metrics of post-operative outcome, as well as the mechanisms that may underlie the relation between gender and post-neurosurgical complications observed here."

By Eleanor McDermid

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