Analysis of Morbidity and Mortality in Patients Undergoing Skull Base Reconstruction

Abstract

The relative rarity of skull base tumors has limited surgeons' ability to report on morbidity and mortality in a large and nationwide patient series. We aimed to assess the impact of reconstructive procedures on patients undergoing skull base surgery and to determine whether 30-day postoperative morbidity and mortality varied between patients who underwent reconstruction and those who did not. We performed a retrospective analysis using American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012 databases. Chi-squared tests were used for categorical variables and t-tests were used for continuous variables. Multiple logistic regression analysis predicted the influence of preoperative and operative variables on complications. A total of 479 patients were included in our study; 199 patients received concurrent reconstruction. There was no statistically significant difference in wound complication, morbidity, length of total hospital stay, and mortality between the 2 groups. The reconstruction cohort showed significantly longer operative times (416.45 [207.585] versus 319.99 [222.813] min, P = 0.001) and higher return to the operating room rate (13.6% versus 6.1%, P = 0.005). Reconstruction using pedicled flaps was associated with increased odds of wound complications (odds ratio, 4.937; P = 0.023), and microsurgical reconstruction was associated with return to the operating room (odds ratio, 2.212; P = 0.015). According to logistic regression, dyspnea, diabetes mellitus, functional status, and tumor involving the central nervous system were associated with complications. This study is the first comprehensive analysis of reconstruction after skull base surgery. Additional measures involved in flap reconstruction are associated with an increase in operation time and return to the operating room rate but not with complications, morbidity, or mortality.

Increased Defect Size is Associated with Increased Complication Rate after Free Tissue Transfer for Midanterior Skull-Base Reconstruction

“…Many authors have reported postoperative complications of skull-base surgery and its risk factors. 1,[4][5][6][7] The reported complication rate is 11.5 to 63%, 1,4,5 reflecting a certain width of range. One of the largest series among them, which included 1,193 cases, 1 showed a complication rate of 36.3% and described medical comorbidity, history of radiation therapy, and the extent of intracranial tumor involvement as independent predictors.…”

“…Some authors have developed systems for the classification of skull-base defects. [5][6][7][8][9] Urken et al presented a classification system for skull-base reconstruction based on the resected regions other than the skull-base. 5 The classification system was a little complicated and complications were not compared based on the classification in his study.…”

Predictors of Short‐term Morbidity and Mortality in Open Anterior Skull Base Surgery

“…Third, the current study aimed to focus on the morbidity and mortality profile of only the ablative/resection component of open anterior skull base surgery, and did not factor in reconstruction. In light of this, an ACS‐NSQIP study comparing those cases that underwent skull base reconstruction and those that did not found that there was no significant difference in complications, death, or length of stay between the two groups . Fourth, it is worthwhile to note that patients who undergo open approaches to the skull base tend to have significantly more advanced disease (e.g., skin, orbital, vascular involvement), indicating that patient selection is potentially biased toward worse outcomes.…”

Reconstruction of Large Tissue Defects After the Resection of Brain Tumors Using a Skin Flap With Vascular Pedicle

“…Free flaps are versatile for reconstructing defects resulting from resections of the skull base, but the impact of reconstructive procedures on the overall morbidity and mortality of patients undergoing skull base surgery needs to be considered. Kim et al 17 analyzed the data of 199/479 patients who underwent reconstruction after skull base surgery. This study showed that additional measures involved in flap reconstruction are associated with an increasing operation time and return to the operating room rate but not with complications, morbidity, or mortality.…”