IMPORTANCE: Open anterior cranial fossa surgery is uncommonly performed, and previous reporting of complications and outcomes have been limited to single-institution, small case series.
OBJECTIVE: To describe rates of complications and death within 30 days of open anterior skull base surgery using a large, multi-institutional outcomes database.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014.
MAIN OUTCOMES AND MEASURES: Complications (medical, surgical, overall), reoperations, and death. Multivariate regression was performed to identify covariates which independently predicted a negative outcome.
RESULTS: A total of 336 open anterior skull base surgeries were identified. 109 (32.4%) patients experienced a complication, reoperation, or mortality. The most common events were postoperative transfusion (15.8%), reoperation (10.1%), and readmission (8.0%). Significant independent predictors of any adverse event included increased preoperative serum alkaline phosphatase (p=0.004), higher ASA score (p=0.005), and increased total operative time (p<0.001). The only predictor of mortality was higher ASA score (p=0.02). Predictors of increased hospital stay included impaired sensorium (p=0.04), coma > 24 hours (p<0.001), lower preoperative hematocrit (p=0.02), higher ASA score (p=0.04), and increased total operative time (p<0.001).
CONCLUSIONS AND RELEVANCE: Open anterior skull base surgery is understandably complex, and is thus associated with a relatively high adverse event rate. Knowledge of factors associated with adverse events will likely encourage preoperative optimization of controllable variables and translate into improved surgical outcomes.