====== Inpatient Neurosurgical Mortality ======

===== 📊 General Overview =====
Neurosurgical inpatient mortality varies depending on patient characteristics, pathology, and surgical context.

  * **General neurosurgical admissions**: 2.7 % – 4.5 %
  * **Adult elective admissions (≥18 years)**: ~1.95 % during stay
  * **30-day post-discharge mortality**: +2.5 % (approx.)

===== 💥 Chronic Subdural Hematoma (cSDH) =====

Study: US national database (2016–2020, >14,000 patients age ≥40)

  * **Surgical group**: 3.6 % in-hospital mortality
  * **Medical (non-surgical)**: 10.9 % in-hospital mortality
  * Surgery improved survival but was associated with higher complication rates.

===== 👤 Elderly & Frailty =====

  * **Elderly patients (≥65 years)**: ~4 % inpatient mortality
  * **Frailty impact**: ~63 % increased risk of death (OR 1.63)
    * Associated with:
      - More postoperative complications
      - Longer length of stay
      - Higher discharge to rehabilitation or long-term care

===== 🧠 High-Risk Conditions =====

  * **Severe traumatic brain injury (TBI) with ICP monitoring**:  
    - ~29.3 % in-hospital mortality  
    - 69 % of deaths due to primary brain injury
  * **Neurosurgical healthcare-associated infections**:  
    - ~11 % inpatient mortality

===== ✅ Summary Table =====

^ Clinical Scenario                             ^ Inpatient Mortality Rate ^
| General neurosurgical admissions             | 2.7 – 4.5 %               |
| Elective adult admissions                    | ~1.95 %                   |
| Chronic subdural hematoma (surgical)         | 3.6 %                     |
| Chronic subdural hematoma (non-surgical)     | 10.9 %                    |
| Elderly patients (≥65)                       | ~4 %                      |
| Severe TBI with ICP monitoring               | ~29.3 %                   |
| Neurosurgical infections                     | ~11 %                     |

===== ⚠️ Key Risk Factors =====

  * **Procedure type** (e.g., craniotomy, TBI, cSDH)
  * **Patient-specific risks**: Age, frailty, comorbidities
  * **Medical complications**: Especially infections
  * **Care setting**: Neurocritical care units show better outcomes

===== 📌 Conclusions =====

  * Most neurosurgical patients have low inpatient mortality (<4 %)
  * Non-operative management (e.g., cSDH) or acute TBI increases risk substantially
  * Frailty is a powerful predictor, often more than age alone
  * In-hospital death is only part of total perioperative risk – 30-day mortality adds significant burden

----

===== 🇩🇪 Germany: 2023 Inpatient Mortality Study =====

In a cross‑sectional analysis, Kamp et al. from:

  * Brandenburg Medical School Theodor Fontane, Neuruppin  
  * Immanuel Clinic Rüdersdorf (Palliative and Neuropalliative Care)  
  * University Hospitals in Heidelberg, Bonn, Jena, Essen  
  * European Radiosurgery Center Munich  
  * Witten/Herdecke University  
  * St. Barbara‑Klinik Hamm‑Heessen  

published in the ''Neurosurgical Review'' Journal, analyzed 2023 in-hospital neurosurgical mortality using nationwide billing data in Germany.

  * **Total cases**: 222,158  
  * **In-hospital deaths**: 8,338  
  * **Overall mortality**: 3.8 %  
  * **Sex disparity**: Men 4.2 % vs Women 3.3 %  
  * **High mortality in**: Traumatic and hemorrhagic conditions  
  * **Surgical intervention mortality range**: 1–9 %

Study offers a national benchmark but relies entirely on administrative data.

----

==== 🧪 Critical Review ====

  * **Methodology fragility**:  
    Reliance on §21 InEK billing data means:
    - No clinical validation  
    - No severity or comorbidity adjustment  
    - No timing of events  

  * **Misinterpretation danger**:  
    Raw mortality rates without risk stratification are misleading.  
    The reported sex difference may reflect unadjusted confounders.

  * **Incremental novelty**:  
    Similar national audits (UK, US) already exist.  
    This adds little beyond local replication.

  * **Discussion gaps**:  
    Authors admit no causal inference, but still present data as benchmarks.  
    They ignore biases like repeated admissions or misclassification.

  * **Logical leaps**:  
    Quoting procedure-specific mortality (e.g. 9 % for vascular cases)  
    without clinical context may unfairly penalize high-risk centers.

  * **Overstated conclusions**:  
    Suggesting policy relevance or clinical utility is unconvincing  
    without proper risk modeling.

----

===== Final Verdict =====
**Flawed epidemiological exercise.**  
Too crude for benchmarking; lacks clinical depth; no actionable utility.

===== Takeaway Message for Neurosurgeons =====
Do **not** use raw mortality data from this study to compare providers.  
Instead, push for **risk-adjusted, registry-based outcome tracking**.

===== Bottom Line =====
An incomplete administrative snapshot.  
**Inadequate for policy, benchmarking, or clinical decision-making.**

===== Rating (0–10) =====
**2/10** — Large dataset undermined by methodological and interpretative weakness.

===== Citation =====
{{cite>
Kamp MA, Jungk C, Schneider M, Fehler G, Santacroce A, Dinc N, Ebner FH, von Sass C, et al. **Inpatient neurosurgical mortality in Germany: a comprehensive analysis of 2023 in‑hospital data.** ''Neurosurgical Review''. 2025 Jun 23;48(1):525. doi:10.1007/s10143-025-03664-1. PMID:40545502.  
Received: 10 Feb 2025; Revised: 19 May 2025; Accepted: 8 Jun 2025.  
Corresponding author: Marcel A. Kamp <marcelalexander.kamp@gmail.com>.
}}