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  • Unplanned Reoperation After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis

    Final Number:
    145

    Authors:
    Hormuzdiyar H. Dasenbrock MD; Sandra C. Yan BS, BA; Vamsidhar Chavakula MD; William B. Gormley MD; Timothy R. Smith MD, PhD, MPH; Elizabeth Claus MD; Ian F. Dunn MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: While reoperation has been utilized as a metric of quality of care, no national analysis has evaluated the rate of, reasons for, and predictors of unplanned reoperation after craniotomy for tumor.

    Methods: Patients who underwent cranial tumor resection were extracted from the prospective National Surgical Quality Improvement Program registry (2012-2014). Multivariable logistic regression examined predictors of an unplanned cranial reoperation. Predictors screened included patient age; sex; tumor location and histology; functional status; comorbidities; preoperative laboratory values; operative urgency and time.

    Results: Of the 11,462 patients included, 3.1% (n=350) underwent an unplanned cranial reoperation. The most common reasons for cranial reoperation were intracranial hematoma evacuation (21.4%), superficial or intracranial surgical site infections (11.6%), re-resection of tumor (9.8%), decompressive craniectomy (6.1%), and repair of cerebrospinal fluid leakage (5.6%). The strongest predictor of any cranial reoperation was preoperative thrombocytopenia (less than 100,000/µL, odds ratio (OR)=2.51, 95% confidence interval (CI): 1.23-5.10, p=0.01). Thrombocytopenia, hypertension, emergent surgery, leukocytosis, and operative time greater than 300 minutes were predictors of reoperation for hematoma (p=0.004), while dependent functional status, morbid obesity, and longer operative time were predictors of reoperation for surgical site infections (p=0.03). Infratentorial location, American Society of Anesthesiologists (ASA) class 3-5 designation, dependent functional status, leukocytosis, and operative time greater than 300 minutes were all predictors of reoperation for ventricular shunt placement (p=0.02). Although any unplanned cranial reoperation was not associated with differential odds of mortality (OR=1.68, 95% CI: 0.94-3.00, p=0.08), hematoma evacuation was significantly associated with thirty-day death (OR=2.09, 95% CI: 1.03-4.25, p=0.04).

    Conclusions: In this NSQIP analysis, unplanned cranial reoperation was primarily associated with operative indices, rather than preoperative characteristics, suggesting that reoperation may have utility as a quality indicator. Hypertension and thrombocytopenia are potentially modifiable predictors of reoperation for hematoma, which were associated greater odds of thirty-day death.

    Patient Care: This NSQIP analysis highlights predictors of unplanned reoperation, including the association of reoperation with thrombocytopenia, and suggests that reoperation may have some utility as a quality metric.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the most common reasons for reoperation; 2) identify predictors of unplanned reoperation; and 3) discuss the potential benefits to the usage of reoperation as a quality indicator.

    References:

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