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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2025; 86(02): 234-242
DOI: 10.1055/a-2263-1778
Original Article

Morbid Obesity and Diabetes Increase the Risk of Reoperation following Microvascular Decompression: A National Surgical Quality Improvement Program Analysis of 1,303 Patients

Alper Dincer
1   Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, United States
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Joanna K. Tabor
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Alexandros F. Pappajohn
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Joseph O'Brien
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Saul Morales-Valero
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Miri Kim
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
,
Jennifer Moliterno
2   Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
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Abstract

Background Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS.

Methods Patient data from 2015 to 2020 were obtained from the American College of Surgeons–National Surgical Quality Improvement Program database and were included in this study if they had a procedure corresponding to an MVD with the current procedural terminology code 61458. Patient demographics, comorbidities, and outcomes were analyzed. Patients were subsequently categorized based on body mass index (BMI) and a logistic regression analysis was used to model the association of comorbidities with reoperation and its indication.

Results The overall rate of reoperation in the cohort is 3.2 and 7.2% for patients with morbid obesity (BMI ≥ 40; p = 0.006). Patients with morbid obesity were more likely to present at a younger age (50.1 vs. 57.4; p < 0.0001), have comorbidities such as hypertension (60.9 vs. 33.5%; p < 0.0001) and diabetes (16.3 vs. 7.7%; p = 0.0002), and increased procedure duration (179 vs. 164 minutes; p = 0.02). Indications for reoperation include cerebrospinal fluid (CSF) leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation.

Conclusion We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reoperation.

Keywords

obese - pain - trigeminal neuralgia - microvascular decompression - surgical complications - reoperation


Publikationsverlauf

Eingereicht: 18. September 2023

Angenommen: 28. Januar 2024

Accepted Manuscript online:
07. Februar 2024

Artikel online veröffentlicht:
18. März 2024

© 2024. The Author(s). 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/)

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