Publication

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

Journal Paper/Review - May 2, 2018

Units
PubMed
Doi

Citation
Stienen M, Ferroli P, Sarnthein J, Krayenbühl N, Bozinov O, Schiavolin S, Villa S, Seggewiss D, Broggi M, Zhang D, Regli L. The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors. J Neurooncol 2018; 139:441-448.
Type
Journal Paper/Review (English)
Journal
J Neurooncol 2018; 139
Publication Date
May 2, 2018
Issn Electronic
1573-7373
Pages
441-448
Brief description/objective

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.