The semisitting position: analysis of the risks and surgical outcomes in a contemporary series of 425 adult patients undergoing cranial surgery

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OBJECTIVE

The objective of this study was to analyze the incidence of the primary complications related to positioning or surgery and their impact on neurological outcome in a consecutive series of patients undergoing elective surgery in the semisitting position.

METHODS

The authors prospectively collected and retrospectively analyzed data from adult patients undergoing elective surgery in the semisitting position for a cranial disease. Patients were managed perioperatively according to a standard institutional protocol, a standardized stepwise positioning, and surgical maneuvers to decrease the risk of venous air embolism (VAE) and other complications. Intraoperative and postoperative complications were recorded. Neurointensive care unit (NICU) length of stay (LOS) and hospital LOS were the intermediate endpoints. Neurological outcome was the primary endpoint as determined by the modified Rankin scale (mRS) score at 6 months after surgery.

RESULTS

Four hundred twenty-five patients were included in the analysis. VAE occurred in 90 cases (21%) and it made no significant statistical difference in NICU LOS, hospital LOS, and neurological outcome. No complication was directly related to the semisitting position, although 46 patients (11%) experienced at least 1 surgery-related complication and NICU LOS and hospital LOS were significantly prolonged in this group. Neurological outcome was significantly worse for patients with complications (p < 0.0001).

CONCLUSIONS

Even in the presence of intraoperative VAE, the semisitting position was not related to an increased risk of postoperative deficits and can represent a safe additional option for the benefit of specific surgical and patient needs.

ABBREVIATIONS ASA = American Society of Anesthesiologists; BMI = body mass index; IQR = interquartile range; LOS = length of stay; NICU = neurointensive care unit; mRS = modified Rankin Scale; PACU = postanesthesia care unit; PFO = patent foramen ovale; VAE = venous air embolism.

Article Information

Correspondence Andrea Saladino, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Via Celoria, 11, Milan 20133, Italy. email: andrea.saladino@gmail.com.

INCLUDE WHEN CITING Published online December 16, 2016; DOI: 10.3171/2016.8.JNS16719.

Drs. Saladino and Lamperti contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Intraoperative positioning. Noninterrupted lines define the relationships between the head, neck, trunk, and inferior limbs during the central time of the operation. Interrupted lines show the steep Trendelenburg position used from skin incision to dura mater opening. Inset: Transthoracic Doppler positioning.

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