Retrospective analysis of perioperative factors on outcome of patients undergoing surgery for Moyamoya disease

BACKGROUND: The short term outcome of patients undergoing surgery for Moyamoya disease can be affected by various perioperative factors. However, due to lesser prevalence of this disease in our country, data relating the effect of perioperative factors on the overall neurological outcomes of these patients is lacking. AIMS: To analyze the effect of perioperative factors on the duration of postoperative hospital stay in patients undergoing surgery for Moyamoya disease. SETTINGS AND DESIGN: It is a retrospective study analyzing various perioperative factors influencing the overall outcome of patients undergoing surgery for Moyamoya disease at a tertiary care centre in North India. METHODS AND MATERIAL: The medical records of all patients who underwent revascularization surgeries for Moyamoya disease from 2007 to till January 2014 were included for retrospective analysis. Various preoperative, intraoperative, and postoperative data were recorded. The data was statistically compared for short and prolonged hospital stay for various perioperative factors. The duration of post operative hospital stay was categorized as short (<5 days) and prolonged (>5 days). STATISTICAL ANALYSIS: Kolmogrov Smirnov test was applied to see the normality of continuous data. The association of various categorically classified data with 2 groups was found using Fisher Exact test. The trends in intraoperative hemodynamics were analysed using 2 way repeated measure Anova test. T-test was used for comparing two group means for various parameters. RESULTS: A total of 15 patients were included in the study. One patient underwent surgery twice on two different occasions. Thirteen patients belonged to paediatric age group (<18 years). The type of anaesthetics used for induction and maintenance had no effect on patient outcome. Mean duration of anaesthesia was 2.45 (1.3-4.0) hours. The mean duration of hospital stay was 5.13 (3-10) days. Most of the parameters did not have significant effect on postoperative hospital stay. Patients with mean value of intraoperative end tidal carbon dioxide (EtCO(2)) either less than 31 mmHg or more than 35 mmHg had statistically significant prolongation of hospital stay. CONCLUSION: Maintaining the intraoperative EtCO(2) between 31-35 mmHg may be associated with short hospital stay when compared to those who have intraoperative EtCO(2) either less than 31 mmHg or more than 35 mmHg.