Introduction: Malignant brain tumors are the most common primary brain tumor, and newer evidence has supported more aggressive resections as a mode to improve survival. The purpose of this study is to estimate the incidence of surgical complications and associated in-hospital morbidity and mortality following surgery for malignant brain tumors.

Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002 – 2011. All adult patients who underwent elective brain surgery for a malignant brain tumor were included. Surgical complications included wrong side surgery, retention of a foreign object, iatrogenic stroke, meningitis, hemorrhage/hematoma complicating a procedure, and neurological complications. Two cohorts (surgical complication and no surgical complication) were analyzed to compare in-hospital mortality, length of stay, hospital costs, and complication development.

Results: A total of 16,530 admissions were analyzed, with 601 (36.2 events per 1,000 cases) surgical complications occurring in 567 patients. The most common complication was iatrogenic stroke, with an incidence of 16.3 per 1,000 cases. Over the examined 10-year period, the overall incidence of surgical complications did not change (P = 0.061) except for iatrogenic strokes, which increased in incidence from 14.1 to 19.8 events per 1,000 between 2002 and 2011 (P = 0.023). Patients who developed a surgical complication had significantly longer lengths of stay, total hospital costs, and higher rates of other complications. Patients who experienced an iatrogenic stroke had a significantly increased risk of mortality (OR 9.6; 95% 6.3 – 14.8) and so were patients with a hemorrhage/hematoma (OR 3.3; 95% CI 1.6 – 6.6).

Conclusions: In this study, patients undergoing surgery for a malignant brain tumor who suffered from a surgical complication had significantly longer lengths of stay, higher hospital charges, and more complications. Having a surgical complication was an independent risk factor for in-hospital mortality. Nonetheless, it is unclear whether all surgical complications were clinically relevant.

Patient Care: Give insight into the potential complications of overly-aggressive surgery for brain tumor resection.

Learning Objectives: 1. Know the incidence of surgical complications following malignant brain tumor surgery resection 2. Know the trends in surgical complications following malignant brain tumor surgery over a 10-year period

References: 1. Zacharia BE, Deibert C, Gupta G, et al. Incidence, cost, and mortality associated with hospital-acquired conditions after resection of cranial neoplasms. Neurosurgery. Jun 2014;74(6):638-647. 2. Landriel Ibanez FA, Hem S, Ajler P, et al. A new classification of complications in neurosurgery. World Neurosurg. May-Jun 2011;75(5-6):709-715; discussion 604-711.