15-year longitudinal study of mortality in a general neurosurgical practice

Abstract

This paper analyses patient mortality rates in a prospectively acquired database of all admissions under one consultant neurosurgeon over a 15-year period from April 1999 to March 2014. Out of 6006 admissions, there were 163 deaths (2.7%). Surgical mortality was 3.0% (129/4255 cases). In 105 of the surgical patients, the aim of surgery was recorded preoperatively as being ‘to save life’ (81%). 14 patients had surgery for pathology that was not life threatening (11%) – four had burr hole surgery for a chronic subdural haematoma and one died after surgical treatment for subarachnoid haemorrhage. Seven died from complications of tumour surgery and two died following epilepsy surgery. A further ten died after endovascular treatment of an aneurysm (9%). The average annual mortality was 10.8 cases (standard deviation +/− 3.06). 147 patients were admitted as an emergency (90%). Only five patients were admitted from a waiting list to be classified as elective retrospectively. The paper helps to define that vital element of neurosurgery practice, which involves the management of patients with life-threatening pathology. Elective mortality rates may be a truer representation of individual surgical competence but these do not reflect overall neurosurgical practice.

Keywords::

• audit
• mortality
• neurosurgery
• outcome

Declaration of interest: No work resembling the enclosed article has been published or is being submitted for publication elsewhere. No financial support was required to produce this paper and there are no potential conflicts of interest.