CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(03): 173-176
DOI: 10.1055/s-0038-1666889
Brief Report
Indian Society of Neuroanaesthesiology and Critical Care

Perioperative, Single-Surgeon Experience in Cerebrovascular Bypass Procedures at Academic Medical Center and Community Hospital

Kathleen W. Nissman
1   American Anesthesiology of North Carolina, Raleigh, North Carolina, United States
Ali R. Zomorodi
2   Department of Neurosurgery, Duke University, Durham, North Carolina, United States
Dhanesh K. Gupta
3   Department of Anesthesiology, Duke University, Durham, North Carolina, United States
Ishwori Dhakal
4   Department of Biostatistics, Duke University, Durham, North Carolina, United States
Yi-Ju Li
4   Department of Biostatistics, Duke University, Durham, North Carolina, United States
Michael L. James
3   Department of Anesthesiology, Duke University, Durham, North Carolina, United States
5   Department of Neurology, Duke University, Durham, North Carolina, United States
› Author Affiliations
Funding This study was funded by the Department of Anesthesiology, Duke University, Durham, North Carolina, United States.
Further Information

Publication History

Received: 21 February 2018

Accepted after revision: 07 June 2018

Publication Date:
03 July 2018 (online)


Background Little evidence exists for superiority of neurosurgical outcomes from care subspecialization. Outcomes of a single neurosurgeon after complex vascular neurosurgery in an academic medical center were compared against those in a community hospital.

Methods In this retrospective analysis of extracranial-intracranial vascular bypass operations performed between July 1, 2013 and February 1, 2015, cases were identified by cross-referencing the electronic medical record with the surgeon's own records. Pre-, intra-, and postoperative variables were abstracted from cases performed at a tertiary center and a community hospital. Dichotomous postoperative data recorded included extubation in the operating room (OR), readmission, and survival to discharge, and length of stay was also analyzed. Due to small sample size and low readmission rate, Firth's penalized likelihood tests were incorporated in the logistic regression model for parameter estimation and testing.

Results A total of 28 hemispheres in 26 patients were included: 18 hemispheres in 16 patients at the tertiary center and 10 hemispheres in 9 patients at the community hospital. Differences were found in operative time (tertiary mean: 7.21 + 2.5 hours, community mean: 5.19 + 0.9 hours, p = 0.0074) and readmission to the tertiary center (p = 0.078). However, significant difference was observed only for anesthetic type (more likely to include remifentanil and propofol at the tertiary center, p = 0.0104).

Conclusion Subspecialty care alone may be insufficient to enhance outcome after complex neurosurgical procedures.

  • References

  • 1 Mirski MA, Chang CW, Cowan R. Impact of a neuroscience intensive care unit on neurosurgical patient outcomes and cost of care: evidence-based support for an intensivist-directed specialty ICU model of care. J Neurosurg Anesthesiol 2001; 13 (02) 83-92
  • 2 Terada Y, Inoue S, Tanaka Y, Kawaguchi M, Hirai K, Furuya H. The impact of postoperative intensive care on outcomes in elective neurosurgical patients in good physical condition: a single centre propensity case-matched study. Can J Anaesth 2010; 57 (12) 1089-1094
  • 3 Varelas PN, Eastwood D, Yun HJ. et al. Impact of a neurointensivist on outcomes in patients with head trauma treated in a neurosciences intensive care unit. J Neurosurg 2006; 104 (05) 713-719
  • 4 Hallemeier CL, Rich KM, Grubb Jr RL. et al. Clinical features and outcome in North American adults with moyamoya phenomenon. Stroke 2006; 37 (06) 1490-1496
  • 5 Houkin K, Kamiyama H, Abe H, Takahashi A, Kuroda S. Surgical therapy for adult moyamoya disease. Stroke 1996; 27 (08) 1342-1346
  • 6 Chiu D, Shedden P, Bratina P, Grotta JC. Clinical features of moyamoya disease in the United States. Stroke 1998; 29 (07) 1347-1351
  • 7 Inoue T, Ohwaki K, Tamura A, Tsutsumi K, Saito I, Saito N. Postoperative transient neurological symptoms and chronic subdural hematoma after extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases: negative effect on cognitive performance. Acta Neurochir (Wien) 2016; 158 (01) 207-216