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- Title
The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors.
- Authors
Stienen, Martin N.; Zhang, David Y.; Broggi, Morgan; Seggewiss, Dominik; Villa, Stefano; Schiavolin, Silvia; Bozinov, Oliver; Krayenbühl, Niklaus; Sarnthein, Johannes; Ferroli, Paolo; Regli, Luca
- 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.
- Subjects
PREOPERATIVE period; INTRACRANIAL tumors; MICROSURGERY; MORTALITY; QUALITY of life; TUMOR treatment
- Publication
Journal of Neuro-Oncology, 2018, Vol 139, Issue 2, p441
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-018-2882-9