Abstract
Accurate knowledge of individualized risks is crucial for decision-making in the surgical management of patients with brain tumors. Precise delineation of those risks remains a topic of debate. We attempted to create a predictive model of outcomes in patients undergoing craniotomies for tumor resection (CTR). We performed a retrospective cohort study involving patients who underwent CTR from 2005 to 2010 and were registered in the American College of Surgeons National Quality Improvement Project database. A model for outcome prediction based on individual patient characteristics was developed. Of the 1,834 patients, 457 had meningiomas (24.9 %) and 1377 had non-meningioma tumors (75.1 %). The respective 30-day postoperative risks were 2.1 % for stroke, 1.3 % for MI, 2.7 % for death, 2.4 % for deep surgical site infection, and 6.6 % for return to the OR. Multivariate analysis demonstrated that pre-operative tumor-related neurologic deficit, stroke, altered mental status, and weight loss, were independently associated with most outcomes, including post-operative MI, death, and deep surgical site infection. An additive effect of the variables on the risk of all outcomes was observed. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated by the area under the receiver operating characteristic curve, which was 0.687, 0.929, 0.749, 0.746, and 0.679 for postoperative risk of stroke, MI, death, infection, and return to the OR, respectively. Our model can provide individualized estimates of the risks of post-operative complications based on pre-operative conditions, and can potentially be utilized as an adjunct in the decision-making for surgical intervention in brain tumor patients.
Similar content being viewed by others
References
Fisher ES, McClellan MB, Safran DG (2011) Building the path to accountable care. N Engl J Med 365(26):2445–2447
Chang SM, Parney IF, McDermott M et al (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the glioma outcome project. J Neurosurg 98(6):1175–1181
Rabadán AT, Hernandez D, Eleta M et al (2007) Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 68(4):412–420
Blanshard HJ, Chung F, Manninen PH, Taylor MD, Bernstein M (2001) Awake craniotomy for removal of intracranial tumor: considerations for early discharge. Anesth Analg 92(1):89–94
Bohinski RJ, Kokkino AK, Warnick RE et al (2001) Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 48(4):731–742
Brell M, Ibáñez J, Caral L, Ferrer E (2000) Factors influencing surgical complications of intra-axial brain tumours. Acta Neurochir (Wien) 142(7):739–750
Cabantog AM, Bernstein M (1994) Complications of first craniotomy for intra-axial brain tumour. Can J Neurol Sci 21(3):213–218
Ciric I, Ammirati M, Vick N, Mikhael M (1987) Supratentorial gliomas: surgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurgery 21(1):21–26
Meyer FB, Bates LM, Goerss SJ et al (2001) Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. Mayo Clin Proc 76(7):677–687
Sawaya R, Hammoud M, Schoppa D et al (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055
Schulder M, Liang D, Carmel PW (2001) Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager. J Neurosurg 94(6):936–945
Taylor WA, Thomas NW, Wellings JA, Bell BA (1995) Timing of postoperative intracranial hematoma development and implications for the best use of neurosurgical intensive care. J Neurosurg 82(1):48–50
Vives KP, Piepmeier JM (1999) Complications and expected outcome of glioma surgery. J Neurooncol 42(3):289–302
Lassen B, Helseth E, Rønning P et al (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68(5):1259–1268
Solheim O, Jakola AS, Gulati S, Johannesen TB (2012) Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study. J Neurosurg 116(4):825–834
Patil CG, Veeravagu A, Lad SP, Boakye M (2010) Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the national surgical quality improvement program. J Neurol Neurosurg Psychiatry 81(5):502–505
Barker FG 2nd (2004) Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000: decreasing mortality and the effect of provider caseload. Cancer 100(5):999–1007
Barker FG 2nd, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988–2000: the effect of provider caseload and centralization of care. Neuro Oncol 7(1):49–63
Curry WT, McDermott MW, Carter BS, Barker FG 2nd (2005) Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102(6):977–986
Davenport DL, Holsapple CW, Conigliaro J (2009) Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University Health System Consortium Clinical Database and the National Surgical Quality Improvement Program data set. Am J Med Qual 24(5):395–402
Devaux BC, O’Fallon JR, Kelly PJ (1993) Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78(6):767–775
Fadul C, Wood J, Thaler H, Galicich J, Patterson RH Jr, Posner JB (1988) Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurology 38(9):1374–1379
Kreth FW, Warnke PC, Scheremet R, Ostertag CB (1993) Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78(5):762–766
Taylor MD, Bernstein M (1999) Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 90(1):35–41
Vorster SJ, Barnett GH (1998) A proposed preoperative grading scheme to assess risk for surgical resection of primary and secondary intraaxial supratentorial brain tumors. Neurosurg Focus 4(6):e2
Black P, Kathiresan S, Chung W (1998) Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 140(10):1013–1016
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Additional information
Kimon Bekelis and Samuel F. Bakhoum have contributed equally to this study and co-primary authors.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Bekelis, K., Bakhoum, S.F., Desai, A. et al. Outcome prediction in intracranial tumor surgery: the National Surgical Quality Improvement Program 2005–2010. J Neurooncol 113, 57–64 (2013). https://doi.org/10.1007/s11060-013-1089-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-013-1089-3