Inpatient Neurosurgical Mortality

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.)

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

• Severe traumatic brain injury (TBI) with ICP monitoring:
  1. ~29.3 % in-hospital mortality
  2. 69 % of deaths due to primary brain injury
• Neurosurgical healthcare-associated infections:
  1. ~11 % inpatient mortality

• 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

• 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

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.

• Methodology fragility:

Reliance on §21 InEK billing data means:

1. No clinical validation
2. No severity or comorbidity adjustment
3. 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.

Flawed epidemiological exercise. Too crude for benchmarking; lacks clinical depth; no actionable utility.

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

An incomplete administrative snapshot. Inadequate for policy, benchmarking, or clinical decision-making.

2/10 — Large dataset undermined by methodological and interpretative weakness.

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>.