Introduction: Intracranial metastases are a common neurological complication in oncologic patients. As management options in radiation, chemotherapy, targeted therapy, and surgery have continued to advance, the role of resection for intracranial metastases has become increasingly important. We sought to characterize rates of post-operative complications relative to a intracranial meningioma, a more benign pathology that usually undergoes resection.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) provides patient characteristics and 30 day outcomes after craniotomy for intracranial metastases from 2011 to 2015. Multivariate logistic regression analysis was utilized for statistical analysis.
Results: A total of 2,492 patients who underwent resection of intracranial metastasis were identified. The most common major complications amongst these patients were readmission (13.4%), reoperation (4.9%), venous thromboembolism (VTE) (3.2%), and death (2.9%). Resection of intracranial metastases carried 2.5-fold higher odds for death (95% CI 1.6-3.9; p<0.01) and 2.1-fold higher odds of readmission (95% CI 1.2-3.7, p=0.01) than resection of intracranial meningioma within 30 days post-operatively. There was no difference in odds of reoperation for intracranial metastases or meningioma. Indications for reoperation following resection of intracranial metastases included insertion of VP shunt (14.0%), tumor debulking (7.0%), and evacuation of SDH (6.1%) and ICH (6.1%) amongst others. Odds of developing post-operative VTE, cardiac arrest, and common peri-operative infections (pneumonia, UTI, wound infection) were similar following resection for intracranial metastasis and meningioma. Interestingly, odds of post-operative cerebrovascular accidents were 3.4-fold lower in the intracranial metastasis cohort (95% CI: 2.1-5.4 , p<0.01).
Conclusions: Resection for intracranial metastases was associated with increased odds of death and readmission, but not reoperation, VTE, cardiac arrest, and infection than resection of intracranial meningioma within 30 days.
Patient Care: Clinicians will be better prepared to judge the benefits and risks of resection of intracranial metastases with an understanding of the major complications and the factors which predict them.
Learning Objectives: By the end of this session, presenters should be able to:
1) Describe the most common complications within 30 days of intracranial metastasis resection.
2) Discuss how the odds of developing complications differs between resection of intracranial metastasis and meningioma
3) Compare the safety of resecting intracranial metastasis with meningioma