Author(s): Srinivasaiah R.; Lemos C.; Spencer L.; Nair V.
Source: Journal of Neurosurgical Anesthesiology; Oct 2019; vol. 31 (no. 4); p. 522-523
Publication Date: Oct 2019
Publication Type(s): Conference Abstract
Abstract:Introduction: An accurate risk score able to predict inpatient mortality helps improve both risk communication and clinical decision making. Preoperative score to predict postoperative mortality (POSPOM) is a risk scoring system developed in France by Le Manach et al can predict inpatient mortality of patients admitted for different surgeries including interventional neuroradiology. POSPOM score is based on patient’s age, comorbidities and the type of planned surgery. We used this new risk scoring system in our hospital to assess its validity in predicting inpatient mortality in INR patients. Method(s): We obtained permission from our hospital’s clinical governance department for the retrospective review of case notes of patients who underwent INR procedures for the treatment of intracranial aneurysms during January 2017 to June 2017. We reviewed 100 case notes out of 126 patients who underwent INR procedures. We collected the data on patient’s age, sex, urgency of the procedure, grade of SAH if it was an emergency procedure, POSPOM score, postoperative destination and complications, inpatient mortality and outcome at 1 year as measured by modified Rankin scale. Result(s): Of the 100 patients, 71 patients were female and 29 patients were male, with an age distribution from 24 to 80 years. A total of 58 patients underwent elective INR procedure and 42 patients had emergency INR procedure for acute subarachnoid haemorrhage (SAH). 52% of the emergency patients belonged to grade 1 SAH and 21% of the patients belonged to grade 5 SAH. The mean POSPOM score was 26 with a range from 20 to 36. Mean POSPOM score was almost similar in both elective and emergency patients. Sixty-seven percent of the patients did not had any postprocedure complications, however, 33 patients had 1 or more complications during their hospital stay. Majority of the patients had good outcome at 1 year with 92 patients with a MRS score of 0 to 3. Four patients died during their hospital stay and 2 of them brainstem dead and were organ donors and 1 patient died within 1 year after the procedure. Discussion(s): The predicted mortality rate for patients with POSPOM score of 26 was 2%. The observed Inpatient mortality was 4% in our study group and an overall mortality rate of 5% within a year. Al the patients who died during their hospital stay had emergency INR procedures. The POSPOM study did not differentiate between elective and emergency surgery. Although our sample size was small in our study group (n = 100) when compared with POSPOM study (n = 2926), we conclude that the mortality rate is higher for the patients undergoing emergency INR procedures when compared to elective INR procedures and POSPOM scoring system may not be a suitable prediction tool for emergency INR patients.