Neurosurgery outcomes and complications in a monocentric 7-year patient registry

Sarnthein, Johannes; Staartjes, Victor E.; Regli, Luca; Akeret, Kevin; Stieglitz, Lennart; Bektas, Delal; Bichsel, Oliver; Bellut, David; Colombo, Elisa; Krayenbühl, Niklaus; Hofer, Anna‐Sophie; Serra, Carlo; Karbe, Arian; Dias, Sandra; Padevit, Luis; Esposito, Giuseppe; Rohr, Jonas; Germans, Menno R.; Samma, A.; Hugelshofer, Michael; Sebök, Martina; Küffer, Alexander; Oertel, Markus Florian; Tosic, Lazar; Faber-Castell, Fabio von; Niftrik, Christiaan Hendrik Bas van; Doormaal, Tristan van; Vasella, Flavio; Stienen, Martin N.; Voglis, Stefanos; Neidert, Marian C.; Bozinov, Oliver

doi:10.1016/j.bas.2022.100860

Cited by 13 publications

(17 citation statements)

References 51 publications

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“…18 In the past years, several grading systems such as the Landriel-Ibañez and Clavien-Dindo classification had been introduced for classifying postoperative complications in a standardized manner. 10,11,19 However, the Comprehensive Complication Index (CCI)…”

Section: Discussionmentioning

confidence: 99%

“…Recently, reporting of postoperative complications as an outcome measure, classifying its severity, defining procedure-related risk factors, and proposals for reducing the frequency attached greater importance. 11,[20][21][22] These studies emphasized the potential implication of the Clavien-Dindo classification (CDC) as a standardized grading system for various neurosurgical procedures. According to the current literature, any adverse event graded as CD I or higher occurs in 13% to 58% of the cases, depending on the specific procedure and defined time interval.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…8,9 In the past years, several grading systems were newly introduced or transferred for neurosurgical procedures, such as the Landriel-Ibañez and Clavien-Dindo classification. 10,11 These classifications are grading each complication separately and the most severe complication is presented as an outcome measure. As this does not represent the overall morbidity of the postoperative course, the Comprehensive Complication Index (CCI) integrating all complications with their respective severity…”

Section: Introductionmentioning

confidence: 99%

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The Comprehensive Complication Index (CCI) as a Measure of Postoperative Morbidity and Neurological Outcome after Elective Intracranial Surgery

Drexler

Pantel

Göttsche

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background: The Comprehensive Complication Index (CCI) is a numerical scale based on the Clavien-Dindo classification (CDC) and both are widely used to assess outcome. However, the CCI had not been described for neurosurgical procedures. Objective: We aimed to investigate the value of the CCI to predict outcome in patients who underwent elective intracranial surgery. Methods: Prospective cohort study including patients who underwent elective intracranial surgery. Complications were graded using CDC, and the CCI was calculated daily. Neurological outcome was assessed using mRS, NANO, NIHSS, and KPS. Results: Of 294 patients who underwent an elective intracranial procedure, 211 (71.8%) patients underwent a craniotomy, while 28 (9.5%) patients had a burr hole procedure and 55 (18.7%) patients a transsphenoidal approach. A higher blood loss was the only significant predictor for a higher CCI (OR 1.09, 95% CI 1.00-1.12, P < 0.01). Patients with a higher CCI had a longer LOS (mean: 5.4 versus 10.9 days, P < 0.01) and ICU stay (mean: 0.8 versus 2.4 days, P < 0.01). Daily CCI revealed a risk for complications after craniotomies until postoperative day (POD) 7. In patients who underwent brain tumor surgery, the resection of meningiomas and metastasis showed a similar developmental course of CCI. A significantly higher CCI was observed in patients who had a neurological deterioration at discharge ( P < 0.01). Conclusion: CCI is a valid scale to measure outcome after intracranial procedures and correlates with neurological outcome. Risk for adverse events after craniotomy is at highest until postoperative day 7.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Comprehensive Complication Index (CCI) as a Measure of Postoperative Morbidity and Neurological Outcome after Elective Intracranial Surgery

Drexler

Pantel

Göttsche

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…We prospectively collected data from the patient registry of the Department of Neurosurgery at the University Hospital Zurich ( 5 ). We screened all patients with initial surgery for anaplastic astrocytoma (WHO grade III) or glioblastoma (WHO grade IV) for eligibility—between January 2013 and June 2017.…”

Section: Methodsmentioning

confidence: 99%

“…Perioperative adverse events (AEs) are an important and sensitive parameter in measuring management quality of the perioperative period (2,3). Importantly, AEs occur frequently during and after neurosurgical interventions and are associated with poor functional status (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Association of perioperative adverse events with subsequent therapy and overall survival in patients with WHO grade III and IV gliomas

et al. 2022

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BackgroundMaximum safe resection followed by chemoradiotherapy as current standard of care for WHO grade III and IV gliomas can be influenced by the occurrence of perioperative adverse events (AE). The aim of this study was to determine the association of AE with the timing and choice of subsequent treatments as well as with overall survival (OS).MethodsProspectively collected data of 283 adult patients undergoing surgery for WHO grade III and IV gliomas at the University Hospital Zurich between January 2013 and June 2017 were analyzed. We assessed basic patient characteristics, KPS, extent of resection, and WHO grade, and we classified AE as well as modality, timing of subsequent treatment (delay, interruption, or non-initiation), and OS.ResultsIn 117 patients (41%), an AE was documented between surgery and the 3-month follow-up. There was a significant association of AE with an increased time to initiation of subsequent therapy (p = 0.005) and a higher rate of interruption (p < 0.001) or non-initiation (p < 0.001). AE grades correlated with time to initiation of subsequent therapy (p = 0.038). AEs were associated with shorter OS in univariate analysis (p < 0.001).ConclusionAEs are associated with delayed and/or altered subsequent therapy and can therefore limit OS. These data emphasize the importance of safety within the maximum-safe-resection concept.

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Cauda equina syndrome — from timely treatment to the timing of out–of-hours surgery

Demetriades

2022

Acta Neurochir

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Neurosurgery outcomes and complications in a monocentric 7-year patient registry

Cited by 13 publications

References 51 publications

The Comprehensive Complication Index (CCI) as a Measure of Postoperative Morbidity and Neurological Outcome after Elective Intracranial Surgery

The Comprehensive Complication Index (CCI) as a Measure of Postoperative Morbidity and Neurological Outcome after Elective Intracranial Surgery

Association of perioperative adverse events with subsequent therapy and overall survival in patients with WHO grade III and IV gliomas

Cauda equina syndrome — from timely treatment to the timing of out–of-hours surgery

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