Preoperative identification of neurosurgery patients with a high risk of in-hospital complications: a prospective cohort of 418 consecutive elective craniotomy patients

Abstract

OBJECT Patients undergoing craniotomy are routinely assessed preoperatively, yet the role of these assessments in predicting outcome is poorly studied. This study aimed to identify preoperative factors predicting in-hospital outcome after cranial neurosurgery. METHODS The study cohort consisted of 418 consecutive adults undergoing elective craniotomy for any intracranial lesion. Apart from the age criteria (≥ 18 years), almost all patients were considered eligible for the study to increase external validity of the results. The studied preoperative assessments included various patient-related data, routine blood tests, American Society of Anesthesiologists (ASA) Physical Status Classification system, and a local modification of the ASA classification (Helsinki ASA classification). Adverse outcomes were in-hospital mortality, in-hospital systemic or infectious complications, and in-hospital CNS deficits. Resource use was defined as length of stay (LOS) in the intensive care unit and overall LOS in the hospital. RESULTS The in-hospital mortality rate was 1.0%. In-hospital systemic or infectious complications and permanent or transient CNS deficits occurred in 6.7% and 11.2% of the patients, respectively. Advanced age (≥ 60–65 years), elevated C-reactive protein level (> 3 mg/L), and high Helsinki ASA score (Class 4) were associated with in-hospital systemic and infectious complications, and a combination of these could identify one-fourth of the patients with postoperative complications. Moreover, this combination of preoperative assessment parameters was significantly associated with increased resource use. CONCLUSIONS In this first prospective and unselected cohort study of outcome after elective craniotomy, simple preoperative assessments identified patients with a high risk of in-hospital systemic or infectious complications as well as extended resource use. Presented risk assessment methods may be widely applicable, also in low-volume centers, as they are based on composite predictors and outcome events.

Patient Satisfaction and Short-Term Outcome in Elective Cranial Neurosurgery

“…Of the 83 functionally dependent patients at 30 days, 56 patients already had an mRS score $3 preoperatively. Further subgroup analyses showed that patients with a 30-day mRS score $3, in addition to more often having a preoperative mRS score $3 (P , .001), had higher preoperative ASA scores (P = .02) and Helsinki ASA scores (P = .004), 11 were older (P , .001), had higher Charlson Comorbidity Index score (P = .002) and had a longer hospital LOS (P , .001). This subgroup also had a higher proportion of malignant tumors (55.4% vs 22.8%, P , .001; OR: 4.2, 95% CI: 2.5-7.1) and a lower proportion of benign tumors (18.1% vs 34.1%, P = .006; OR: 0.4, 95% CI: 0.2-0.8).…”

“…The protocol of patient enrollment and exclusion criteria were described in a previous article. 11 In brief, of 551 eligible patients, 85 (15.4%) were excluded due to logistic problems in obtaining informed consent before surgery; 47 (8.5%) refused to participate. One patient withdrew the consent during the study.…”

Impact of preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma undergoing repeated operation

“…Increased risk of perioperative complications has been reported in surgeries such as brain tumor craniotomy [12][13][14][15][16][17]. Reportedly, the length of hospital day after tumor resection is significantly longer in patients with high ASA scores than in those with low ASA scores [12].…”

“…Reportedly, the length of hospital day after tumor resection is significantly longer in patients with high ASA scores than in those with low ASA scores [12]. Reponen et al reported that high ASA scores are associated with increased systemic and infectious complications [17]. A more recent study has confirmed that high ASA scores are one of the independent risk factors for surgical site infection after craniotomy [18].…”

“…Increased postsurgical complications in patients with glioma with low KPS have been reported by several groups [4,[9][10][11]. In addition, the American Society of Anesthesiologists (ASA) score, which is a widely used clinical preoperative physical status classification, is a well-known risk factor for preoperative mortality and complications after craniotomy in patients with various brain tumors [12][13][14][15][16][17][18]. However, little is known about the impact of KPS and ASA scores in patients who undergo craniotomy for recurrent glioma.…”