Microvascular decompression surgery in the United States: mortality rates, morbidity rates, and the effects of hospital and surgeon volume.

(Thesis from 2003 issue of ‘Neurosurgery’)

Kalkanis SN and others of Harvard University Massachusetts General Hospital reported a very interesting outcome of their research in 2003. Microvascular decompression that was performed in special medical centers showed low mortality and morbidity rate, but microvascular decompression was also being performed in places that were not special centers. The researchers used the national discharged patients database to research the immediate results.

Microvascular decompression performed from 1996 to 2000 included 1326 performed for trigeminal neuralgia, 237 for facial spasm, and 27 for glassopharyngeal neuralgia. This was done in 305 hospitals and 277 neurosurgeons. Overall mortality rate was 0.3% and 3.8% of the patients did not return home after discharge. Neurological complications were 1.7% (hematoma 0.5%, facial palsy 0.6%, 0.4% needed ventricle puncture, and 0.7% needed a respirator after surgery). Age, sex, race, insurance, diagnosis, region, and other factors were controlled and after comparison it showed that the hospitals that perform more microvascular decompression and the neurosurgeons that perform more microvascular decompression showed better results after discharge. Complications were also less in neurosurgeons that perform more microvascular decompression. The mortality rate did not change with more experience and there was no difference in time of hospitalization and amount of surgeries. However, the hospitals that performed more surgeries were a little more expensive.

Although most microvascualr decompression is performed in centers that perform a small amount of surgery, the mortality rate was kept very low. However, complications were lower enough in hospitals and neurosurgeons that perform more surgeries to be noticeable.