2025 Proffered Presentations
S334: PREDICTORS OF 30-DAY POSTOPERATIVE MORBIDITY AND MORTALITY IN SKULL-BASE SURGICAL APPROACHES BY ANATOMICAL SUBSITE: A NSQIP ANALYSIS
Asha Krishnakumar, BA1; Ashwin Ghadiyaram, BS1; Hayden M Dux, BS1; William C Broaddus, MD, PhD2; 1Virginia Commonwealth University School of Medicine; 2Virginia Commonwealth University Department of Neurosurgery
Objective: Skull-base surgical approaches, when studied by anatomical subsites, have their own scope and rate of complications, but can have significant risks of morbidity and mortality. While previous studies have investigated predictive factors for morbidity and mortality in skull-base surgery, the present study seeks to study predictors of postoperative morbidity and mortality in skull-base surgery specific to subsites in the anterior cranial fossa (ACF), middle cranial fossa (MCF), and posterior cranial fossa (PCF).
Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2015 to 2018 for adult patients with CPT codes corresponding to skull-base surgical approaches. Data collected included age, gender, race, BMI, and comorbidities including smoking, diabetes, COPD, and CHF. 30-day postoperative probabilities of morbidity and mortality were calculated using logistic regression analysis based on the NSQIP risk calculator. Multivariate analyses were performed for morbidity and mortality probabilities, and rate of surgical complications.
Results: 3,142 patients underwent skull-base surgery, including 266 (8.5%) in the ACF cohort, 272 (8.7%) in the MCF cohort, and 2,604 (82.9%) in the PCF cohort.
The PCF cohort (0.037+0.068) had a significantly higher mortality probability than those of the ACF (0.0074+0.014; p<0.001) and MCF cohorts (0.0092+0.020; p<0.001). PCF surgery also had a higher morbidity probability (0.114+0.053) than those of the ACF (0.096+0.044; p<0.001) and MCF cohorts (0.096+0.042; p<0.001), and there was no significant difference between mortality (p=0.233) and morbidity probabilities (p=0.810) of ACF and MCF approaches.
Predictors of mortality only in the PCF approach were diabetes (β=0.015; p<0.001) and CHF (β=0.18; p<0.001) and morbidity only in the PCF approach included CHF (β=0.11; p<0.001). Diabetes also predicted a higher rate of surgical complications only in the PCF approach (β=0.09; p<0.001). However, a higher BMI was associated with increased morbidity in only the ACF (β=0.002; p<0.001) and MCF (β=0.0018; p<0.001) approaches. Older age was associated with mortality in all three approaches (ACF: β=0.0003; p<0.001; MCF: β=0.00046; p<0.001; PCF: β=0.0013; p<0.001), and morbidity in all three (ACF: β=0.001; p<0.001; MCF: β=0.001; p<0.001; PCF: β=0.0012; p<0.001), along with smoking (ACF: β=0.025; p<0.001; MCF: β=0.028; p<0.001; PCF: β=0.023; p<0.001).
Table 1. Multivariate Regression Results of Significant Predictors of Morbidity, Mortality, and Surgical Complications in Anterior Cranial Fossa (ACF), Middle Cranial Fossa (MCF), and Posterior Cranial Fossa (PCF) Skull-Base Approaches
Figure 1. Morbidity and Mortality (Mean +/- SD) in all Three Approaches
Conclusion: Surgical approaches to the PCF had a significantly higher morbidity and mortality probability compared to ACF and MCF surgery, and had different predictors of morbidity, mortality, and rate of surgical complications when compared to the other two anatomical sites, although older age and smoking were negative predictors for surgery in all three sites. Further research can identify areas for further improvement in skull-base surgery by anatomical subsite to improve patient quality of life.