Header

UZH-Logo

Maintenance Infos

The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors


Stienen, Martin N; Zhang, David Y; Broggi, Morgan; Seggewiss, Dominik; Villa, Stefano; Schiavolin, Silvia; Bozinov, Oliver; Krayenbühl, Niklaus; Sarnthein, Johannes; Ferroli, Paolo; Regli, Luca (2018). The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors. Journal of Neuro-Oncology, 139(2):441-448.

Abstract

INTRODUCTION: The decision whether to operate on patients with intracranial tumors is complex and influenced by patient-specific factors, including the preoperative functional status. This work assesses the risks for mortality and complications, and post-operative recovery in functionally dependent patients undergoing microsurgical resection of intracranial tumors.
METHODS: Observational two-center study, analyzing institutional registry data. Dependency was defined as admission Karnofsky Performance Scale (KPS) of ≤ 50. The primary endpoint was in-hospital mortality. Secondary endpoints were rate and type [Clavien-Dindo grade (CDG)] of complications, as well as postoperative change in KPS until the 3-month follow-up (M3).
RESULTS: Of n = 1951 patients, n = 98 (5.0%) were dependent. Mortality rates were 2.0% for dependent and 0.4% for independent patients (p = 0.018). In univariable analysis, dependent patients were more likely than independent patients to die in hospital (OR 5.49, 95% CI 1.12-26.8, p = 0.035). In a multivariable model, the effect was slightly attenuated (OR 4.75, 95% CI 0.91-24.7, p = 0.064). Dependent patients tended to experience more postoperative complications. They were more likely to suffer from a severe complication (CDG 4 and 5; OR 3.55, 95% CI 1.49-8.46, p = 0.004). In 40.8 and 52.4% of cases, dependent patients regained functional independence at discharge and M3, respectively.
CONCLUSIONS: In operated patients with intracranial tumors presenting functionally dependent at admission, the risk for in-hospital mortality and complications is elevated. However, if conducted successfully, surgery may lead to regain of independence in every second patient within 3 months.

Abstract

INTRODUCTION: The decision whether to operate on patients with intracranial tumors is complex and influenced by patient-specific factors, including the preoperative functional status. This work assesses the risks for mortality and complications, and post-operative recovery in functionally dependent patients undergoing microsurgical resection of intracranial tumors.
METHODS: Observational two-center study, analyzing institutional registry data. Dependency was defined as admission Karnofsky Performance Scale (KPS) of ≤ 50. The primary endpoint was in-hospital mortality. Secondary endpoints were rate and type [Clavien-Dindo grade (CDG)] of complications, as well as postoperative change in KPS until the 3-month follow-up (M3).
RESULTS: Of n = 1951 patients, n = 98 (5.0%) were dependent. Mortality rates were 2.0% for dependent and 0.4% for independent patients (p = 0.018). In univariable analysis, dependent patients were more likely than independent patients to die in hospital (OR 5.49, 95% CI 1.12-26.8, p = 0.035). In a multivariable model, the effect was slightly attenuated (OR 4.75, 95% CI 0.91-24.7, p = 0.064). Dependent patients tended to experience more postoperative complications. They were more likely to suffer from a severe complication (CDG 4 and 5; OR 3.55, 95% CI 1.49-8.46, p = 0.004). In 40.8 and 52.4% of cases, dependent patients regained functional independence at discharge and M3, respectively.
CONCLUSIONS: In operated patients with intracranial tumors presenting functionally dependent at admission, the risk for in-hospital mortality and complications is elevated. However, if conducted successfully, surgery may lead to regain of independence in every second patient within 3 months.

Statistics

Citations

Dimensions.ai Metrics
3 citations in Web of Science®
4 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

1 download since deposited on 16 May 2018
0 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:brain tumor, care, complications, functional dependence, mortality, neuro-oncology, outcome
Language:English
Date:2018
Deposited On:16 May 2018 14:42
Last Modified:07 May 2019 11:50
Publisher:Springer
ISSN:0167-594X
OA Status:Green
Publisher DOI:https://doi.org/10.1007/s11060-018-2882-9
PubMed ID:29721751

Download

Download PDF  'The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors'.
Preview
Content: Accepted Version
Filetype: PDF
Size: 710kB
View at publisher