Risk of Complications After Intracranial Procedures at High Altitude

Abstract

Background: Postoperative hemorrhagic or ischemic complications cause significant morbidity and mortality after craniotomy. High altitude creates a state of relative hypoxia, resulting in increased cerebral blood flow for compensation. This potentially creates an increased risk at high altitude of having increased morbidity from hemorrhagic or ischemic events, and some neurosurgeons forbid air travel to patients immediately after craniotomy for this reason. We hypothesized there was no difference in postoperative complications based on altitude.

Methods: We retrospectively reviewed all craniotomies performed at a high-altitude medical center to assess whether originating, surgical, or destination altitude affected postoperative outcomes.

Results: Between 1 July 2014 and 30 June 2016, 1807 craniotomy procedures were performed. There were 53 (2.9%) postoperative hemorrhagic or ischemic complications during the first 30 days after surgery, 44 (2.4%) hemorrhagic events, and 9 (0.5%) ischemic events. From the 36 patients who had postoperative complications at the hospital, 10 of them lived in an altitude below the hospital, 26 lived in an altitude above the hospital, and 1 has no record of address. Excluding the patients who had complications at the hospital, we had 8 patients discharged to a ZIP code below the altitude of the hospital (7 hemorrhagic events and 1 ischemic) and 9 were discharged to a location at an altitude above that of the hospital (8 hemorrhagic events and 1 ischemic). There were no statistically significant differences between cohorts.

Conclusions: Altitude does not appear to have a significant impact on postoperative rates of hemorrhagic or ischemic complications.

Keywords: Craniotomy; Hemorrhage; High altitude; Infarct; Postoperative complications.