Introduction: Primary malignant brain tumors frequently result in serious morbidity and mortality. The National Surgical Quality Improvement Program (NSQIP) tracks surgical patients for 30 days postoperatively. This national registry was used to evaluate the cumulative incidence and predictors of major complication, reoperation, readmissions, and death after surgery.
Methods: Patients who underwent a craniotomy for a primary malignant brain tumor were extracted from the NSQIP registry (2006-2015). Multivariable logistic regression was used to identify predictors of major complications, reoperation, readmission and death.
Results: 7376 patients were identified, of which 948 (12.9%) experienced a major complication at a median of 9 days after surgery. 82.3% of the major complications occurred within the initial hospital stay. The most common major complications were reoperation (5.1%), venous thromboembolism (VTE, 3.5%), and death (2.6%). The most common reasons for reoperation and readmission were intracranial hemorrhage (18.5%) and wound related complications (11.9%), respectively (Figure 1). Multivariable analysis identified old age, high body mass index (BMI), longer operative times, higher American Society of Anesthesiologists (ASA)-classification, pre-operative white blood cell count (WBC) above 12,000 cells per mm3, and dependent functional status as independent predictors for major complication (all p<.001). Older age, higher ASA-classification, and dependent functional status were also found predictive for death (all p<.001). For readmission, higher ASA-classification and dependent functional status were identified as predictors (all p<.001). For reoperation, higher ASA-classification, higher BMI, longer operative times, and WBC >12,000 cells per mm3 were identified as predictors (all p<.001 except BMI (p=.04)).
Conclusions: The overall rate of major complications after malignant brain tumor resection is not negligible, and most occur during the initial hospital stay. Age, ASA-classification, and functional status were identified as predictors for both major complications and mortality. Intracranial hemorrhage and wound related complications were the major causes of reoperation and readmission, respectively.
Patient Care: This study provides a better understanding of the drivers of major complications, reoperation, readmission, and death within 30 days after craniotomy for a primary malignant brain tumor. This could help in identifying high-risk patients and tailor postoperative management to their individual risk profile.
Learning Objectives: By the conclusion of this session, participants should:
1. Be familiar with the most common major complications within 30 days after craniotomy for a primary malignant brain tumor, and their timing relative to hospital stay.
2. Have knowledge of the major causes of reoperation and readmission, respectively.
3. Understand the drivers for major complications, reoperation, readmission, and death within 30 days after craniotomy for primary malignant brain tumors.