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

  • Clinical Study
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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.

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Acknowledgements

The authors thank all resident and faculty neurosurgeons who entered and validated the patient data in the institutional patient registries that were basis of this research.

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Author notes

  1. Martin N. Stienen and David Y. Zhang contributed equally to the production of this work and should therefore both be regarded as first authors.

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Martin N. Stienen, David Y. Zhang, Dominik Seggewiss, Oliver Bozinov, Niklaus Krayenbühl, Johannes Sarnthein & Luca Regli

  2. Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Morgan Broggi, Stefano Villa & Paolo Ferroli

  3. Department of Neurosurgery, Charité University Medical Center, Berlin, Germany

    Dominik Seggewiss

  4. Public Health and Disability Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

    Silvia Schiavolin

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  1. Martin N. Stienen
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Correspondence to Martin N. Stienen.

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Stienen, M.N., Zhang, D.Y., Broggi, M. et al. The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors. J Neurooncol 139, 441–448 (2018). https://doi.org/10.1007/s11060-018-2882-9

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  • DOI: https://doi.org/10.1007/s11060-018-2882-9

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