Introduction: Seizures are among the most common perioperative complications in patients undergoing craniotomy for brain tumor resection and have been associated with increased disease progression and decreased survival. Little evidence exists regarding the relationship between post-operative seizures and hospital quality measures, including length of stay (LOS), disposition, and readmission.

Methods: Patients with glioma undergoing craniotomy for resection between 1998 and 2014 were enrolled into our institutional tumor registry. Demographics, comorbidities, hospitalization details, and complications were recorded. Seizures were diagnosed by clinical exam, observation, and EEG. Student t-test and multivariate logistic regression were used to analyze differences in means between continuous and categorical variables, respectively.

Results: 636 patients with glioma underwent craniotomy for resection, 346 of which sufficient data was available for study inclusion. Median age was 50.4 years with mean/median survival time of 26.6/15.7 months. 76% of patients had high-grade glioma (Grade III/IV). Perioperative antiepileptic drugs were administered in 86% of patients. Seventeen (4.9%) patients experienced a seizure within 14 days post-operatively, 9 (53%) of which were first-time seizures. Mean time to first post-operative seizure was 3.5 days (range 0-13 days). Compared to their seizure-free counterparts, patients experiencing a perioperative seizure had increased average hospital (7.4 vs. 3.1, p<0.001) and ICU (5.9 vs. 2.1, p<0.001) LOS. Patients with a post-operative seizure were significantly more likely to be discharged to a rehabilitation facility than to home (OR=2.57, p=0.02), and were more likely to be readmitted within 90 days (OR=3.795, p=0.008).

Conclusions: Patients with perioperative seizures following glioma resection endured longer hospital and ICU LOS, were more likely to be discharged to a rehabilitation facility, and were readmitted at higher rates than seizure-free patients. Efforts to reduce the risk of post-operative seizure should remain a priority among tumor neurosurgeons.

Patient Care: The authors hope this research will redirect attention toward the importance of post-operative seizures in elective tumor surgery, not only to the surgeon and patient, but to the healthcare system in general. Subsequently, we - along with others - will be examining specific risk factors for post-operative seizure in an effort to mitigate this risk via patient awareness & selection, surgical technique, and consideration of pharmacologic seizure prophylaxis.

Learning Objectives: -Discuss the nature and occurrence of post-operative seizures following glioma resection - Understand the impact of perioperative seizures on hospital quality metrics including length of stay and readmission

References: 1. Deutschman CS, Haines SJ: Anticonvulsant prophylaxis in neurological surgery. Neurosurgery 17:510–517, 1985 2. Drappatz J, Schiff D, Kesari S, Norden AD, Wen PY: Medical management of brain tumor patients. Neurol Clin 25:1035–71– ix, 2007 3. Forsyth PA, Weaver S, Fulton D, Brasher PMA, Sutherland G, Stewart D, et al.: Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci 30:106–112, 2003 4. Glantz MJ, Cole BF, Friedberg MH, Lathi E, Choy H, Furie K, et al.: A randomized, blinded, placebo-controlled trial of divalproex sodium prophylaxis in adults with newly diagnosed brain tumors. Neurology 46:985–991, 1996 5. Marcus LP, McCutcheon BA, Noorbakhsh A, Parina RP, Gonda DD, Chen C, et al.: Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010). J Neurosurg 120:1201–1211, 2014