Abstract
Background Cranial surgery is associated with multiple postoperative complications varying from
simple nausea and vomiting to devastating complications such as stroke and death.
This multicentre collaborative effort was envisioned to collect observational data
regarding postoperative complications in cranial surgeries among the Indian population.
The aim of this study was to describe the postoperative neurological complications
occurring within the first 24 hours after surgery and to identify the predictive factors.
Methods Data was collected from three participating tertiary care academic institutions.
The study was prospective, observational, multicentre design with data collected over
a period of two months or 100 cases, whichever is earlier, from each participating
institute. A predesigned Microsoft excel sheet was distributed among all three centers
to maintain uniformity. All patients aged 18 years and above of both sexes undergoing
elective or emergency craniotomies were included in the study. The postoperative neurological
complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined
as new focal neurological motor deficit relative to preoperative status. (2) Sensorium
deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points
compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure
activity. All possible variables associated with the above neurological complications
were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors,
which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5%
was taken as significant.
Results Data from three institutions was collected with a total of 279 cases. In total, there
were 53 (19%) neurological complications. There were 28 patients with new postoperative
NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological
deficits were significantly less in institution 2. Diagnosis of traumatic brain injury
(TBI) was associated with very low risk of ND, and vascular pathology was associated
with higher chance of a ND. The duration of anesthesia was found to be significantly
predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS.
Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%,
and 6.1%, respectively. Studies with a much larger sample size are required for a
better and detailed analysis of these complications.
Keywords
postoperative complications - neurosurgery - neurological deficit
