Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;34(2):201-208.
doi: 10.1097/ANA.0000000000000756.

Using the Postoperative Morbidity Survey to Measure Morbidity After Cranial Neurosurgery

Astri M V Luoma  1   2 , Deborah R Douglas  1 , Linda D'Antona  3   2 , Ahmed K Toma  3   2 , Martin Smith  1   2
Affiliations

Using the Postoperative Morbidity Survey to Measure Morbidity After Cranial Neurosurgery

Astri M V Luoma et al. J Neurosurg Anesthesiol. .

Abstract

Background: The incidence of morbidity after cranial neurosurgery is significant, reported in up to a quarter of patients depending on methodology used. The Postoperative Morbidity Survey (POMS) is a reliable method for identifying clinically relevant postsurgical morbidity using 9 organ system domains. The primary aim of this study was to quantify early morbidity after cranial neurosurgery using POMS. The secondary aims were to identify non-POMS-defined morbidity and association of POMS with postoperative hospital length of stay (LOS).

Materials and methods: A retrospective electronic health care record review was conducted for all patients who underwent elective or expedited major cranial surgery over a 3-month period. Postsurgical morbidity was quantified on postoperative days (D) 1, 3, 5, 8, and 15 using POMS. A Poisson regression model was used to test the correlation between LOS and total POMS scores on D1, 3 and 5. A further regression model was used to test the association of LOS with specific POMS domains.

Results: A total of 246 patients were included. POMS-defined morbidity was 40%, 30%, and 33% on D1, D3, and D8, respectively. The presence of POMS morbidity on these days was associated with longer median (range) LOS: D1 6 (1 to 49) versus 4 (2 to 45) days; D3 8 (4 to 89) versus 6 (4 to 35) days; D5 14 (5 to 49) versus 8.5 (6 to 32) days; D8 18 (9 to 49) versus 12.5 (9 to 32) days (P<0.05). Total POMS score correlated with overall LOS on D1 (P<0.001), D3 (P<0.001), and D5 (P<0.001). A positive response to the "infectious" (D1, 3), "pulmonary" (D1), and "renal" POMS items (D1) were associated with longer LOS.

Conclusion: Although our data suggests that POMS is a useful tool for measuring morbidity after cranial neurosurgery, some important morbidity items that impact on LOS are missed. A neurosurgery specific tool would be of value.

PubMed Disclaimer

Conflict of interest statement

L.D. is supported by an NIHR Academic Clinical Fellowship and was the recipient of a research fellowship sponsored by B. Braun. A.K.T. research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. M.S. is Editor-in-Chief of the Journal of Neurosurgical Anesthesiology: this manuscript was handled by Dr. Alana Flexman, Associate Editor. The remaining authors have no conflicts of interest to disclose

References

    1. Gozal YM, Akture E, Ravindra VM, et al. Defining a new neurosurgical complication classification: lessons learned from a monthly Morbidity and Mortality Conference. J Neurosurg. 2020;132:272–276 10.3171/2018.9.JNS181004 - DOI
    1. Schiavolin S, Broggi M, Acerbi F, et al. The impact of neurosurgical complications on patients’ health status: a comparison between different grades of complications. World Neurosurg. 2015;84:36–40 10.1016/j.wneu.2015.02.008 - DOI
    1. Rolston JD, Han SJ, Lau CY, et al. Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011. J Neurosurg. 2014;120:736–745 10.3171/2013.10.JNS122419 - DOI
    1. Rock AK, Opalak CF, Workman KG, et al. Safety outcomes following spine and cranial neurosurgery: evidence from the national surgical quality improvement program. J Neurosurgl Anesthesiol. 2018;30:328–336 10.1097/ANA.0000000000000474 - DOI
    1. Alexandre V, Guyonaud C, Frasca D, et al. Major complications after scheduled craniotomy: a justification for systematic postoperative intensive care admission? Eur J Anaesthesiol. 2020;37:147–149 10.1097/EJA.0000000000001045 - DOI

LinkOut - more resources