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Infratentorial Neurosurgery Is an Independent Risk Factor for Respiratory Failure and Death in Patients Undergoing Intracranial Tumor Resection

Flexman, Alana M. MD, FRCPC*; Merriman, Bradley MD*; Griesdale, Donald E. MD, FRCPC*; Mayson, Kelly MD, FRCPC*; Choi, Peter T. MD, FRCPC*; Ryerson, Christopher J. MD, FRCPC

Journal of Neurosurgical Anesthesiology: July 2014 - Volume 26 - Issue 3 - p 198–204
doi: 10.1097/ANA.0b013e3182a43ed8
Clinical Investigation

Background: Respiratory failure and death are devastating outcomes in the postoperative period. Patients undergoing neurosurgical procedures experience a greater frequency of respiratory failure compared with other surgical specialties. Resection of infratentorial mass lesions may be associated with an even higher risk because of several unique factors. Our objectives were: (1) to determine the incidence of postoperative respiratory failure and death in the neurosurgical population; and (2) to determine whether infratentorial procedures are associated with a higher risk compared with supratentorial procedures.

Methods: We retrospectively analyzed the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing intracranial tumor resection. The primary outcome was a composite of reintubation within 30 days, failure to wean from mechanical ventilation within 48 hours, and death within 30 days after surgery. We examined the association between the surgical site and the outcomes using multivariate logistic regression.

Results: A total of 1699 patients met inclusion criteria (79% supratentorial and 21% infratentorial). The primary outcome occurred in 3.8% of supratentorial procedures and 6.6% of infratentorial procedures (P=0.02). Infratentorial tumor resection was independently associated with the composite outcome in the final model (odds ratio, 1.75; 95% confidence interval, 1.03-2.99; P=0.04) with the strongest association seen between infratentorial site and death (odds ratio, 2.44; 95% confidence interval, 1.23-4.87; P=0.01).

Conclusions: Infratentorial neurosurgery is an independent risk factor for respiratory failure and death in patients undergoing intracranial tumor resection. Mortality is an important contributor to this risk and should be a focus for future research.

*Department of Anesthesiology, Pharmacology and Therapeutics

Department of Medicine, Division of Respirology, University of British Columbia, Vancouver, BC, Canada

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A.M.F. is supported by a Vancouver Acute Department of Anesthesia Research Merit Award. D.E.G. is supported by a Mentored Clinician Scientist Award from the Vancouver General Hospital and UBC Hospital Foundation.

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

The authors have no conflicts of interest to disclose.

Reprints: Alana M. Flexman, MD, FRCPC, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver General Hospital, Room 2449 JPP 899 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada (e-mail:

Received April 24, 2013

Accepted July 9, 2013

© 2014 by Lippincott Williams & Wilkins