Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis

Abstract

OBJECTIVE Although there is a growing body of research highlighting the negative impact of obesity and malnutrition on surgical outcomes, few studies have evaluated these parameters in patients undergoing intracranial surgery. The goal of this study was to use a national registry to evaluate the association of body mass index (BMI) and hypoalbuminemia with 30-day outcomes after craniotomy for tumor. METHODS Adult patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry. Patients were stratified by body habitus according to the WHO classification, as well as by preoperative hypoalbuminemia (< 3.5 g/dl). Multivariable logistic regression evaluated the association of body habitus and hypoalbuminemia with 30-day mortality, complications, and discharge disposition. Covariates included patient age, sex, race or ethnicity, tumor histology, American Society of Anesthesiology class, preoperative functional status, comorbidities (including hypertension and diabetes mellitus), and additional preoperative laboratory values. RESULTS Among the 11,510 patients included, 28.7% were classified as normal weight (BMI 18.5-24.9 kg/m), 1.9% as underweight (BMI < 18.5 kg/m), 33.4% as overweight (BMI 25.0-29.9 kg/m), 19.1% as Class I obese (BMI 30.0-34.9 kg/m), 8.3% as Class II obese (BMI 35.0-39.9 kg/m), 5.5% as Class III obese (BMI ≥ 40.0 kg/m), and 3.1% had missing BMI data. In multivariable regression models, body habitus was not associated with differential odds of mortality, postoperative stroke or coma, or a nonroutine hospital discharge. However, the adjusted odds of a major complication were significantly higher for Class I obese (OR 1.28, 99% CI 1.01-1.62; p = 0.008), Class II obese (OR 1.53, 99% CI 1.13-2.07; p < 0.001), and Class III obese (OR 1.67, 99% CI 1.19-2.36; p < 0.001) patients compared with those of normal weight; a dose-dependent effect was seen, with increased effect size with greater adiposity. The higher odds of major complications was primarily due to significantly increased odds of a venous thromboembolism in overweight and obese patients, as well as of a surgical site infection in those with Class II or III obesity. Additionally, 41.0% of patients had an albumin level ≥ 3.5 g/dl, 9.6% had hypoalbuminemia, and 49.4% had a missing albumin value. Hypoalbuminemia was associated with significantly higher odds of mortality (OR 1.91, 95% CI 1.41-2.60; p < 0.001) or a nonroutine hospital discharge (OR 1.46, 95% CI 1.21-1.76; p < 0.001). CONCLUSIONS In this National Surgical Quality Improvement Program analysis evaluating patients who underwent craniotomy for tumor, body habitus was not associated with differential mortality or neurological complications. However, obese patients had increased odds of a major perioperative complication, primarily due to higher rates of venous thromboembolic events and surgical site infections. Preoperative hypoalbuminemia was associated with increased odds of mortality and a nonroutine hospital discharge, s...

Smoking and Obesity are Risk Factors for Thirty-Day Readmissions Following Skull Base Surgery

“…Increased surgical site infections have been linked to body habitus and a recent series of 11,510 who underwent a craniotomy for tumor demonstrated that amongst WHO class I to III obese patients, the risk of surgical site infection was significantly higher. 40 Surgical site infection (SSI) is well known as a complication of smoking a recent series of 67,405 patients who underwent spinal surgery showed that smokers were at increased risk of SSI. 41 From our data, it is difficult to form a direct link between risk of 30-day readmission for SSI and smoking; however, smoking is an independent risk factor for SSI and overall numbers of smokers were higher in the readmissions group (35.7%) in our series compared with those not readmitted (20.8%).…”

Postoperative Hypoalbuminemia: Prevalence, Risk Factors, Association with Postoperative Pneumonia in Brain Tumors Patients Undergoing Craniotomy

“…In central nervous system, preoperative hypoalbuminemia affected the prognoses of patients with glioblastomas 13,14 . Hypoalbuminemia is also associated with increased odds of mortality and a nonroutine hospital discharge 7,8 , and is a risk factor for postoperative acute kidney injury in patients who underwent craniotomy for tumor 9 . In addition, hypoalbuminemia is independent predictor of extended hospital stay following brain tumor surgery 10 .…”

“…Hypoalbuminemia is associated with poor postoperative outcomes and complications in patients underwent surgical intervention, such as cardiac 1,2 , hand 3 , colorectal cancer surgery 4 and orthopedic surgery 5,6 . In central nervous system, hypoalbuminemia is also associated with increased odds of mortality and a nonroutine hospital discharge 7,8 , and is a risk factor for postoperative acute kidney injury in patients who underwent craniotomy for tumor 9 . In addition, hypoalbuminemia is independent predictor of extended hospital stay following brain tumor surgery 10 .…”

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

“…Male gender, Hispanic ethnicity, and medium bed size were predictive for PE, whereas chronic heart failure was predictive for DVT [ 3 ]. Other predictors of postoperative VTE identified in the broader group of brain tumor patients were higher BMI, hypertension, functional dependence, lower Karnofsky Performance Scale (KPS) score, motor deficits, ventilator dependence, steroid usage, preoperative sepsis, longer operative times, and higher World Health Organization (WHO) tumor grade [ 11 , 40 , 42 , 43 , 46 ].…”