Background Microvascular decompression (MVD) is the preferred treatment for refractory trigeminal neuralgia (TN) and hemifacial spasm (HFS). MVD provides long-lasting results for these conditions with a relatively low risk of postoperative complications. However, reoperation rates are reported up to 11%, an unacceptably high rate for an elective procedure. We determined what factors may increase the risk of reoperation among patients undergoing MVD for TN or HFS.

Methods Patient data from 2015 to 2020 were obtained from the American College of Surgeons–National Surgical Quality Improvement Program database and were included in this study if they had a procedure corresponding to an MVD with the current procedural terminology code 61458. Patient demographics, comorbidities, and outcomes were analyzed. Patients were subsequently categorized based on body mass index (BMI) and a logistic regression analysis was used to model the association of comorbidities with reoperation and its indication.

Results The overall rate of reoperation in the cohort is 3.2 and 7.2% for patients with morbid obesity (BMI ≥ 40; p = 0.006). Patients with morbid obesity were more likely to present at a younger age (50.1 vs. 57.4; p < 0.0001), have comorbidities such as hypertension (60.9 vs. 33.5%; p < 0.0001) and diabetes (16.3 vs. 7.7%; p = 0.0002), and increased procedure duration (179 vs. 164 minutes; p = 0.02). Indications for reoperation include cerebrospinal fluid (CSF) leak (31%), wound complications (19%), refractory pain (11.9), intracranial hemorrhage (4.8%), and other/unknown (33.3%). Patients with either morbid obesity or diabetes have a 2-fold increase in risk of reoperation, while having both is associated with a 5-fold risk of reoperation.

Conclusions We demonstrate morbid obesity leads to increased procedure duration and increased risk of reoperation due to wound complications and CSF leak. In these patients, alternative treatment strategies or preoperative optimization may be reasonable to reduce the risk of surgical complications and reoperation.

背景 微血管减压（MVD）是难治性三叉神经痛（TN）和面肌痉挛（HFS）的首选治疗方法。MVD 可为这些病症提供持久的效果，且术后并发症的风险相对较低。然而，据报道，再手术率高达 11%，对于择期手术来说，这个比率高得令人无法接受。我们确定了哪些因素可能会增加因 TN 或 HFS 接受 MVD 的患者再次手术的风险。

方法 2015 年至 2020 年的患者数据来自美国外科医生学会 - 国家手术质量改进计划数据库，如果他们接受了与 MVD 相对应的手术（当前手术术语代码为 61458），则将其纳入本研究。患者人口统计、合并症、并对结果进行了分析。随后根据体重指数（BMI）对患者进行分类，并使用逻辑回归分析来模拟合并症与再次手术及其适应症的关联。

结果病态肥胖患者（BMI ≥ 40； p = 0.006） 的总体再手术率为 3.2% 和 7.2%  。病态肥胖患者更有可能出现在较年轻的年龄（50.1 vs. 57.4；p < 0.0001），并患有高血压（60.9% vs. 33.5%； p  < 0.0001）和糖尿病（16.3 vs. 7.7%；p  < 0.0001）等合并症。  = 0.0002），并增加手术持续时间（179 分钟 vs. 164 分钟；p  = 0.02）。再次手术的指征包括脑脊液（CSF）漏（31%）、伤口并发症（19%）、顽固性疼痛（11.9）、颅内出血（4.8%）和其他/未知（33.3%）。患有病态肥胖或糖尿病的患者，再手术的风险增加 2 倍，而同时患有这两种疾病的患者，再手术的风险增加 5 倍。

结论 我们证明病态肥胖会导致手术持续时间增加，并因伤口并发症和脑脊液漏而增加再次手术的风险。对于这些患者，替代治疗策略或术前优化可能是合理的，可以降低手术并发症和再次手术的风险。