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

Martin N. Stienen, David Y. Zhang, Morgan Broggi, Dominik Seggewiss, Stefano Villa, Silvia Schiavolin, Oliver Bozinov, Niklaus Krayenbühl, Johannes Sarnthein, Paolo Ferroli, Luca Regli

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)441-448
Number of pages8
JournalJournal of Neuro-Oncology
Volume139
Issue number2
DOIs
Publication statusPublished - Sep 1 2018

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Mortality
Neoplasms
Karnofsky Performance Status
Hospital Mortality
Registries

Keywords

  • Brain tumor
  • Care
  • Complications
  • Functional dependence
  • Mortality
  • Neuro-oncology
  • Outcome

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

Cite this

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.

In: Journal of Neuro-Oncology, Vol. 139, No. 2, 01.09.2018, p. 441-448.

Research output: Contribution to journalArticle

Stienen, Martin N. ; Zhang, David Y. ; Broggi, Morgan ; Seggewiss, Dominik ; Villa, Stefano ; Schiavolin, Silvia ; Bozinov, Oliver ; Krayenbühl, Niklaus ; Sarnthein, Johannes ; Ferroli, Paolo ; Regli, Luca. / The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors. In: Journal of Neuro-Oncology. 2018 ; Vol. 139, No. 2. pp. 441-448.
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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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AU - Stienen, Martin N.

AU - Zhang, David Y.

AU - Broggi, Morgan

AU - Seggewiss, Dominik

AU - Villa, Stefano

AU - Schiavolin, Silvia

AU - Bozinov, Oliver

AU - Krayenbühl, Niklaus

AU - Sarnthein, Johannes

AU - Ferroli, Paolo

AU - Regli, Luca

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AB - 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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KW - Care

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KW - Mortality

KW - Neuro-oncology

KW - Outcome

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