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  • Neoadjuvant Chemotherapy is an Independent Risk Factor of Stroke, All-Cause Morbidity, and Mortality in Elective Cranial Neurosurgery

    Final Number:
    1448

    Authors:
    Mohamad Bydon MD; Nicholas B. Abt BS; Rafael De la Garza-Ramos MD; Mohamed Macki BA; Rafael J. Tamargo MD; Judy Huang MD; Ali Bydon MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Neoadjuvant chemotherapy (NC) is sometimes utilized prior to primary surgical resection or radiation treatment in intracranial tumors. However, little is known about the effect of NC on postoperative surgical outcomes.

    Methods: Elective cranial neurosurgical patient data was obtained from the American College of Surgeons National Surgical Quality Improvement Program database between 2006 and 2012. The impact of neoadjuvant chemotherapy on 30-day all-cause postoperative morbidity, surgical site infections, and mortality were assessed. Adjusted odds ratios were estimated for surgical site infection, overall morbidity, and mortality using a multivariable logistic regression model, accomplished in stepwise fashion, for patients receiving NC versus those not receiving NC.

    Results: This study analyzed 3,812 patients undergoing elective cranial surgery, with 152 receiving NC. NC patients had a complication rate of 23.68%, while patients not receiving NC had a lower complication rate at 17.65%. Multivariable regression analysis revealed that patients who received NC had significantly increased odds of developing a stroke with neurological deficit (OR=3.39; 95% CI:1.37-8.40) and all-cause postoperative morbidity (OR=1.57; 95% CI:1.04-2.37) over the control group. Finally, the NC cohort demonstrated higher odds of mortality following surgery than their non-NC counterparts (OR=3.81; 95% CI:1.81-8.02). Ninety-two patients (2.41%) died within 30 days, of which 10 (6.58%) receiving NC died versus 82 non-NC (2.24%) deaths (p=0.001).

    Conclusions: Neoadjuvant chemotherapy is associated with an increased risk of short-term stroke with neurological deficit, all-cause morbidity, and mortality in elective cranial neurosurgery.

    Patient Care: This abstract will re-asses the utility of neoadjuvant chemotherapy

    Learning Objectives: 1. Neoadjuvant chemotherapy patients had a complication rate of 23.68%, while patients not receiving neoadjuvant chemotherapy had a lower complication rate at 17.65%. 2. Patients who received a neoadjuvant chemotherapy had a statistically significantly increased odds of developing a stroke with neurological deficit and all-cause postoperative morbidity 3. The neoadjuvant chemotherapy cohort demonstrated statistically significantly higher odds of mortality following surgery than their non-NC counterparts.

    References:

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