Classification of Adverse Events Following Surgery in Patients With Diffuse Lower-Grade Gliomas

Abstract

BackgroundRecently, the Therapy-Disability-Neurology (TDN) was introduced as a multidimensional reporting system to detect adverse events in neurosurgery. The aim of this study was to compare the novel TDN score with the Landriel–Ibanez classification (LIC) grade in a large cohort of patients with diffuse lower-grade glioma (dLGG). Since the TDN score lacks validation against patient-reported outcomes, we described health-related quality of life (HRQoL) change in relation to TDN scores in a subset of patients.MethodsWe screened adult patients with a surgically treated dLGG World Health Organization (WHO) grade 2 and 3 between 2010 and 2020. Up until 2017, it consists of a retrospective cohort (n = 158). From 2017 and onwards, HRQoL was registered using EuroQoL-5-dimension, three levels of response (EQ-5D 3L) questionnaire at baseline and 3 months follow-up, in a prospectively recruited cohort (n = 102). Both the LIC grade and TDN score were used to classify adverse events.ResultsIn total, 231 patients were included. In 110/231 (47.6%) of the surgical procedures, a postoperative complication was registered. When comparing the TDN score to LIC grades, only a minor shift towards complications of higher order could be observed. EQ-5D 3L was reported for 45 patients. Patients with complications related to surgery had pre- to postoperative changes in EQ-5D 3L index values (n = 27; mean 0.03, 95% CI −0.06 to 0.11) that were comparable to patients without complications (n = 18; mean −0.06, 95% CI −0.21 to 0.08). In contrast, patients with new-onset neurological deficit had a deterioration in HRQoL at follow-up, with a mean change in the EQ-5D 3L index value of 0.11 (n = 13, 95% CI 0.0 to 0.22) compared to −0.06 (n = 32, 95% CI −0.15 to 0.03) for all other patients.ConclusionsIn patients with dLGG, TDN scores compared to the standard LIC tend to capture more adverse events of higher order. There was no clear relation between TDN severity and HRQoL. However, new-onset neurological deficit caused impairment in HRQoL. For the TDN score to better align with patient-reported outcomes, more emphasis on neurological deficit and function should be considered.

Significant perioperative parameters affecting postoperative complications within 30 days following craniotomy for primary malignant brain tumors

“…Landriel classification was modified from the classification of complications by Clavien and Dindo to match the need of neurosurgical patients (Manekk et al 2022 ). Currently, the Landriel classification is the most accepted and practiced in neurosurgery based on the interventions required to manage the complications (Gómez Vecchio et al 2021 ). This is the simplest form of classification that can be used to categorize surgical complications and is easily understood by medical and paramedical staff.…”

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

“…Glioma affects patients’ functional status and HRQoL negatively, due to disease- and therapy-related symptoms such as neurocognitive deficits, including visual disorders and communication deficits, disturbed sleep, fatigue, drowsiness, itchy skin, and bladder control issues, and due to associated conditions such as depression and anxiety ( Table 1 ) ( 3 , 46 – 49 , 66 ). Concerns about HRQoL are the main factor in treatment decisions for up to 81% of patients, of whom 81% and 79% – for low- and high-grade glioma, respectively – are primarily concerned with quality of life, not survival, when deciding on treatment ( 52 ).…”

“…Neurological deficits impact 44–50% of patients with glioma before surgery ( 52 , 68 ) and are more than three times more frequent in patients with diffuse glioma than in age- and sex-matched people from the general population ( 68 ), with cognitive performance often declining over time ( 69 ). These deficits have been identified as reducing HRQoL, with new-onset deficits associated with a reduction of 0.17 in EQ-5D 3L index values relative to no deficit in diffuse lower-grade glioma ( 46 ). Data by histology suggested that patients with glioblastoma had worse HRQoL and functioning on domains such as emotion than patients with other glioma (and brain tumors generally) ( 48 ).…”