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

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.