1)
Changing Population – eg. effect of increasingly elderly population, obesity
and co-morbidities on mortality after neuroanaesthesia.
2)
Emergency neurosurgery – communication, in or outside network referrals, transfer
time and time to surgery, seniority of personnel, availability of Level 2/3
care if required, testing and correction of clotting abnormalities.
3)
Hospital Acquired Infections – influence of obesity, diabetes, dexamethasone
and site of surgery on incidence.
4)
Subarachnoid Haemorrhage – age distribution of deaths, timing of interventions,
differences between coiling and clipping, level of care.
5)
Clotting and VTE prophylaxis - CSDH in patients on anticoagulants,
postoperative haemorrhage and VTE prophylaxis, pulmonary embolus, elective
surgery and aspirin or clopidogrel usage.
6)
Planning of services – multidisciplinary input into patient care eg.
geriatricians, endocrinologists, oncologists, microbiology and orthopaedics.
Timing of admission for brain tumour surgery, management of spinal metastases, palliative
care, specialised wards, tracheostomy related issues.
P A Razis
August 2011