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 language | English |
|---|---|
| Pages (from-to) | 441-448 |
| Number of pages | 8 |
| Journal | Journal of Neuro-Oncology |
| Volume | 139 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Sep 1 2018 |
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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 journal › Article
}
TY - JOUR
T1 - The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors
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
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
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.
KW - Brain tumor
KW - Care
KW - Complications
KW - Functional dependence
KW - Mortality
KW - Neuro-oncology
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=85051585451&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051585451&partnerID=8YFLogxK
U2 - 10.1007/s11060-018-2882-9
DO - 10.1007/s11060-018-2882-9
M3 - Article
C2 - 29721751
AN - SCOPUS:85051585451
VL - 139
SP - 441
EP - 448
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
SN - 0167-594X
IS - 2
ER -