Introduction: Hemorrhage is a common reason for reoperation in patients undergoing intracranial tumor surgery. This is often a neurosurgical emergency that without early diagnosis and rapid intervention can lead to irreversible neurological deficits. We sought to identify risk factors for intracranial hemorrhage requiring reoperation in these patients.
Methods: Patients who underwent resection for intracranial tumor, based on Current Procedural Terminology (CPT) codes, were identified from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database. 18,694 patients who underwent intracranial tumor resection for years 2012-2015 were analyzed by univariate and multivariate analysis to identify significant associations with hemorrhage requiring reoperation using SPSS 24.0 software.
Results: 1.1% of the patients in this study experienced a postoperative intracranial hemorrhage requiring reoperation. Eight preoperative variables were found significant by multivariate analysis. Preoperative factors included age >60 years (OR:1.869, CI:1.414-2.471), male sex (OR:1.720, CI:1.301-2.275), >10% weight loss within 6 months (OR:2.325, CI:1.222-4.423), emergent surgery (OR:1.833, CI:1.184-2.839), known bleeding disorder (OR:2.811, CI:1.518-5.206), chronic hypertension (OR:2.265, CI:1.717-2.989), white blood cell count >10,000/mm3 (OR:1.695, CI:1.289-2.230) and platelets <150,000mcL (OR:1.922, CI:1.269-2.910). Reoperation for hemorrhage was also found to be associated with several complications including deep surgical site infection (SSI), superficial SSI, septic shock, deep vein thrombosis, prolonged length of stay, failure to wean from ventilator, reintubation required, stroke, postoperative transfusion, and mortality.
Conclusions: We identified several risk factors for hemorrhage requiring neurosurgical intervention in patients who underwent intracranial tumor surgery. These risk factors may be used to estimate a patients’ hemorrhage risk and guide new treatment paradigms regarding preventative measures. This data may also provide valuable information for shared decision-making with patients and families.
Patient Care: This research will provide clinicians with a better understanding of preoperative factors associated with postsurgical hemorrhage that may be used to better discuss surgical outcomes with patients and families. Additionally, this research provides insight into associated complications and statistics of reoperation for hemorrhage which may be used to further guide care.
Learning Objectives: 1. Identify preoperative risk factors significantly associated with hemorrhage requiring reoperation in patients undergoing intracranial tumor resection.
2. Describe the demographics, co-morbidities, and outcomes of patients who experience severe hemorrhage after undergoing intracranial tumor resection.
3. Explain how this data can better inform clinical decision making and prognostication discussions.