Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0043-1769758
Original Article

A Comparison of Perioperative Complications and Outcomes in Patients Undergoing Cerebral Aneurysm Clipping Performed Ultra-Early (≤ 24 hours) versus Late (> 24 hours): A 7-Year Retrospective Study of 302 Patients

Saipin Muangman
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Manee Raksakietisak 
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Kamheang Vacharaksa
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Kattiya Manomatangkul
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Ekawut Chankaew
2   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Chayasorn Kotchasit
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Penpuk Deepinta
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
,
Sirima Phoowanakulchai 
1   Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
› Author Affiliations Funding This study is supported by grant funds from Siriraj Research Development Fund (R016431077), Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.
› Further Information
   Permissions and Reprints

Abstract

Objectives The intracerebral aneurysm with subarachnoid hemorrhage (SAH) has a high morbidity and mortality rate. This study aimed to compare the incidences of perioperative complications in ultra-early surgery (within 24 hours) with those in late surgery (> 24 hours).

Methods Retrospective data were reviewed for 302 patients who underwent craniotomies with aneurysm clipping between January 2014 and December 2020. Perioperative data were obtained from the medical records and reviewed by the investigators. The complications were compared between ultra-early and late operations. We were interested in major complications such as delayed ischemic neurologic deficit (DIND), intraoperative aneurysm rupture (IAR), and anesthesia-related complications. The short-term (in hospital) and long-term (1 year) outcomes in patients with or without DIND and IAR were compared. The collected data was statistically analyzed.

Results Three hundred and two patients were analyzed, and 264 patients had completed follow-up. The ultra-early cases (150 patients) had a higher American Society of Anesthesiologists physical status, a lower Glasgow Coma Scale, and higher Hunt and Hess scales. The surgeons operated on more cases of the anterior cerebral artery as ultra-early operations. The incidence rates of DIND, IAR, severe hemodynamic instability, and cardiac arrest were 5.6, 8.3, 6.3, and 0.3%, respectively, which were not different between groups. However, the reintubation rate was higher in the ultra-early surgery cases (0 vs. 3.3%, p = 0.023). The DIND and IAR patients had poorer short-term (in hospital) outcomes.

Conclusions There were no differences in major complications between ultra-early and late craniotomy with aneurysm clipping. However, the reintubation rate was strikingly higher in the ultra-early group. Patients with major complications had early, unfavorable outcomes.

Keywords

aneurysm rupture - cerebral aneurysm - complications - delayed ischemic neurologic deficit - outcome - reintubation - ultra-early surgery

Ethical Approval

This study was approved by the Siriraj Institutional Review Board of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (SI 520/2020). All methods were performed in accordance with the Declaration of Helsinki and the international ethical guidelines for human biomedical research.




Publication History

Article published online:
16 April 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Abd-Elsayed AA, Wehby AS, Farag E. Anesthetic management of patients with intracranial aneurysms. Ochsner J 2014; 14 (03) 418-425
    PubMedGoogle Scholar
  • 2 Withayasuk P, Churojana A, Songsaeng D, Aurboonyawat T, Chankaew E. Favorable outcome of endovascular treatment for intracranial aneurysms: a single-center study in Thailand. Asian J Neurosurg 2018; 13 (03) 721-729
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Belavadi R, Gudigopuram SVR, Raguthu CC. et al. Surgical clipping versus endovascular coiling in the management of intracranial aneurysms. Cureus 2021; 13 (12) e20478
    PubMedGoogle Scholar
  • 4 Tomatis A, Trevisi G, Boido B, Perez R, Benech CA. Surgical outcomes and their correlation with increasing surgical experience in a series of 250 ruptured or unruptured aneurysms undergoing microsurgical clipping. World Neurosurg 2019; 130: e542-e550
    CrossrefPubMedGoogle Scholar
  • 5 Ban VS, El Ahmadieh TY, Aoun SG. et al. Prediction of outcomes for ruptured aneurysm surgery: the Southwestern aneurysm severity index. Stroke 2019; 50 (03) 595-601
    CrossrefPubMedGoogle Scholar
  • 6 Huang G, Sun Y, Li J, Xie Z, Tong X. Therapeutic effects of microsurgical clipping at different time points on intracranial aneurysm and prognostic factors. Artery Res 2021; 27 (04) 135-142
    CrossrefGoogle Scholar
  • 7 Wong GKC, Boet R, Ng SCP. et al. Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage. World Neurosurg 2012; 77 (02) 311-315
    CrossrefPubMedGoogle Scholar
  • 8 Lamichhane S, Tripathee S, Bhandari RD. Outcome of microsurgieal clipping of ruptured intracranial aneurysms: an early experience. NJNS 2022; 19 (02) 49-54
    Google Scholar
  • 9 Lage AC, Carvalho MT, Pereira R. et al. Ultra-early versus early aneurysm surgery after subarachnoid Hemorrhage: a retrospective outcome analysis. Braz Neurosurg 2020; 39 (02) 95-100
    Google Scholar
  • 10 Cortegiani A, Gregoretti C, Neto AS. et al; LAS VEGAS Investigators, the PROVE Network, and the Clinical Trial Network of the European Society of Anaesthesiology. Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. Br J Anaesth 2019; 122 (03) 361-369
    CrossrefPubMedGoogle Scholar
  • 11 Koenig HM, Chen J, Sieg EP. Delayed cerebral ischemia: is prevention better than treatment?. J Neurosurg Anesthesiol 2021; 33 (03) 191-192
    CrossrefPubMedGoogle Scholar
  • 12 Yamaki VN, Cavalcanti DD, Figueiredo EG. Delayed ischemic neurologic deficit after aneurysmal subarachnoid hemorrhage. Asian J Neurosurg 2019; 14 (03) 641-647
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Rao GU. Intraoperative rupture of aneurysm: does it add insult to the injury?. J Neurosci Rural Pract 2021; 12 (02) 224-225
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Abaziou T, Tincres F, Mrozek S. et al. Incidence and predicting factors of perioperative complications during monitored anesthesia care for awake craniotomy. J Clin Anesth 2020; 64: 109811
    CrossrefPubMedGoogle Scholar
  • 15 Sharma D, Brown MJ, Curry P, Noda S, Chesnut RM, Vavilala MS. Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury. J Neurosurg Anesthesiol 2012; 24 (03) 178-184
    CrossrefPubMedGoogle Scholar
  • 16 Kwon CH, Kim SH. Intraoperative management of critical arrhythmia. Korean J Anesthesiol 2017; 70 (02) 120-126
    CrossrefPubMedGoogle Scholar
  • 17 Han F, Wang Y, Wang Y. et al. Intraoperative cardiac arrest: a 10-year study of patients undergoing tumorous surgery in a tertiary referral cancer center in China. Medicine (Baltimore) 2017; 96 (17) e6794
    CrossrefPubMedGoogle Scholar
  • 18 Sutthipongkiat E, Palanuphap S, Raksakietisak M. Incidence and contributing factors of anesthesia-related critical events in neurosurgery in a tertiary academic hospital in a developing country: a retrospective study. Thai J Anesthesiol 2022; 48 (04) 281-292
    Google Scholar
  • 19 Wilson L, Boase K, Nelson LD. et al. A manual for the Glasgow Outcome Scale-extended interview. J Neurotrauma 2021; 38 (17) 2435-2446
    CrossrefPubMedGoogle Scholar
  • 20 Siddiq F, Chaudhry SA, Tummala RP, Suri MFK, Qureshi AI. Factors and outcomes associated with early and delayed aneurysm treatment in subarachnoid hemorrhage patients in the United States. Neurosurgery 2012; 71 (03) 670-677 , discussion 677–678
    CrossrefPubMedGoogle Scholar
  • 21 McDonald RJ, McDonald JS, Bida JP, Kallmes DF, Cloft HJ. Subarachnoid hemorrhage incidence in the United States does not vary with season or temperature. AJNR Am J Neuroradiol 2012; 33 (09) 1663-1668
    CrossrefPubMedGoogle Scholar
  • 22 Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med 2006; 355 (09) 928-939
    CrossrefPubMedGoogle Scholar
  • 23 Rhoton Jr AL. The supratentorial arteries. Neurosurgery 2002; 51 (4, Suppl): S53-S120
    PubMedGoogle Scholar
  • 24 Gregory P, Edsell M. Fatigue and the anaesthetist. BJA Educ 2014; 14 (01) 18-22
    Google Scholar
  • 25 Cao CG, Weinger MB, Slagle J. et al. Differences in day and night shift clinical performance in anesthesiology. Hum Factors 2008; 50 (02) 276-290
    CrossrefPubMedGoogle Scholar
  • 26 Gander P, Millar M, Webster C, Merry A. Sleep loss and performance of anaesthesia trainees and specialists. Chronobiol Int 2008; 25 (06) 1077-1091
    CrossrefPubMedGoogle Scholar
  • 27 Howard SK, Rosekind MR, Katz JD, Berry AJ. Fatigue in anesthesia: implications and strategies for patient and provider safety. Anesthesiology 2002; 97 (05) 1281-1294
    CrossrefPubMedGoogle Scholar
  • 28 Saadat H, Bissonnette B, Tumin D. et al. Effects of partial sleep deprivation on reaction time in anesthesiologists. Paediatr Anaesth 2017; 27 (04) 358-362
    CrossrefPubMedGoogle Scholar
  • 29 Benham-Hermetz J, Mitchell V. Safe tracheal extubation after general anaesthesia. BJA Educ 2021; 21 (12) 446-454
    CrossrefPubMedGoogle Scholar
  • 30 Parotto M, Cooper RM, Behringer EC. Extubation of the challenging or difficult airway. Curr Anesthesiol Rep 2020; 10 (04) 334-340
    CrossrefPubMedGoogle Scholar
  • 31 Nithiuthai J, Siriussawakul A, Junkai R, Horugsa N, Jarungjitaree S, Triyasunant N. Do ARISCAT scores help to predict the incidence of postoperative pulmonary complications in elderly patients after upper abdominal surgery? An observational study at a single university hospital. Perioper Med (Lond) 2021; 10 (01) 43
    CrossrefPubMedGoogle Scholar
  • 32 Taufique Z, May T, Meyers E. et al. Predictors of poor quality of life 1 year after subarachnoid hemorrhage. Neurosurgery 2016; 78 (02) 256-264
    CrossrefPubMedGoogle Scholar
  • 33 Gupta SK, Chhabra R, Mohindra S. et al. Long-term outcome in surviving patients after clipping of intracranial aneurysms. World Neurosurg 2014; 81 (02) 316-321
    CrossrefPubMedGoogle Scholar