J Neurol Surg B Skull Base 2019; 80(06): 586-592
DOI: 10.1055/s-0038-1676793
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice

Uma Patnaik
1  Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
2  Department of Otolaryngology–Head and Neck Surgery, Army Hospital, Research and Referral, New Delhi, India
,
Smriti Panda
1  Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Alok Thakar
1  Department of Otolaryngology–Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
Further Information

Publication History

24 June 2018

14 November 2018

Publication Date:
26 December 2018 (online)

Abstract

Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective.

Design This study was designed with consecutive cohort of skull base surgical cases.

Setting Tertiary referral academic center.

Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015.

Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery.

Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity.

Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.