Publication:

Perioperative adverse events in neurosurgery – incidence, pattern and associated factors in a Nigerian tertiary hospital

Background Perioperative adverse events remain important causes of morbidity and mortality after neurosurgery, particularly in resource-constrained settings. This study evaluated their frequency, pattern and associated factors at a Nigerian tertiary hospital.

Methods A retrospective observational study was conducted among patients undergoing cranial or spinal neurosurgical procedures at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, from January 2022 to December 2024. Demographic, clinical, operative and outcome data were extracted from hospital records. Associations were assessed using chi-square or Fisher's exact tests, followed by multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Results Of 126 identified cases, 103 met eligibility criteria. Mean age was 46.9±18.3 years and 65.0% were male. Cranial procedures accounted for 68.9% and emergency procedures for 57.3%. Thirty-four patients (33.0%) experienced at least one perioperative adverse event. The most frequent events were intraoperative hypotension, electrolyte disturbances, excessive blood loss, surgical site infection and reoperation. Neurological improvement occurred in 67.0%, while mortality was 8.7%. Emergency surgery (AOR 2.63, 95% CI 1.10–6.31), ASA III–IV (AOR 2.41, 95% CI 1.01–5.72), blood loss >500 ml (AOR 3.78, 95% CI 1.48–9.67), surgery >4 hours (AOR 2.92, 95% CI 1.19–7.15) and incomplete checklist completion (AOR 3.46, 95% CI 1.01–11.88) were independently associated with adverse events.

Conclusions Perioperative adverse events were common. Strengthened risk assessment, haemostatic management, operative efficiency and complete checklist implementation may support safer neurosurgical care.