Skip to main content

Advertisement

Log in

Outcome prediction in intracranial tumor surgery: the National Surgical Quality Improvement Program 2005–2010

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Accurate knowledge of individualized risks is crucial for decision-making in the surgical management of patients with brain tumors. Precise delineation of those risks remains a topic of debate. We attempted to create a predictive model of outcomes in patients undergoing craniotomies for tumor resection (CTR). We performed a retrospective cohort study involving patients who underwent CTR from 2005 to 2010 and were registered in the American College of Surgeons National Quality Improvement Project database. A model for outcome prediction based on individual patient characteristics was developed. Of the 1,834 patients, 457 had meningiomas (24.9 %) and 1377 had non-meningioma tumors (75.1 %). The respective 30-day postoperative risks were 2.1 % for stroke, 1.3 % for MI, 2.7 % for death, 2.4 % for deep surgical site infection, and 6.6 % for return to the OR. Multivariate analysis demonstrated that pre-operative tumor-related neurologic deficit, stroke, altered mental status, and weight loss, were independently associated with most outcomes, including post-operative MI, death, and deep surgical site infection. An additive effect of the variables on the risk of all outcomes was observed. A validated model for outcome prediction based on individual patient characteristics was developed. The accuracy of the model was estimated by the area under the receiver operating characteristic curve, which was 0.687, 0.929, 0.749, 0.746, and 0.679 for postoperative risk of stroke, MI, death, infection, and return to the OR, respectively. Our model can provide individualized estimates of the risks of post-operative complications based on pre-operative conditions, and can potentially be utilized as an adjunct in the decision-making for surgical intervention in brain tumor patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fisher ES, McClellan MB, Safran DG (2011) Building the path to accountable care. N Engl J Med 365(26):2445–2447

    Article  PubMed  CAS  Google Scholar 

  2. Chang SM, Parney IF, McDermott M et al (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the glioma outcome project. J Neurosurg 98(6):1175–1181

    Article  PubMed  Google Scholar 

  3. Rabadán AT, Hernandez D, Eleta M et al (2007) Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 68(4):412–420

    Article  PubMed  Google Scholar 

  4. Blanshard HJ, Chung F, Manninen PH, Taylor MD, Bernstein M (2001) Awake craniotomy for removal of intracranial tumor: considerations for early discharge. Anesth Analg 92(1):89–94

    Article  PubMed  CAS  Google Scholar 

  5. Bohinski RJ, Kokkino AK, Warnick RE et al (2001) Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 48(4):731–742

    PubMed  CAS  Google Scholar 

  6. Brell M, Ibáñez J, Caral L, Ferrer E (2000) Factors influencing surgical complications of intra-axial brain tumours. Acta Neurochir (Wien) 142(7):739–750

    Article  CAS  Google Scholar 

  7. Cabantog AM, Bernstein M (1994) Complications of first craniotomy for intra-axial brain tumour. Can J Neurol Sci 21(3):213–218

    PubMed  CAS  Google Scholar 

  8. Ciric I, Ammirati M, Vick N, Mikhael M (1987) Supratentorial gliomas: surgical considerations and immediate postoperative results. Gross total resection versus partial resection. Neurosurgery 21(1):21–26

    Article  PubMed  CAS  Google Scholar 

  9. Meyer FB, Bates LM, Goerss SJ et al (2001) Awake craniotomy for aggressive resection of primary gliomas located in eloquent brain. Mayo Clin Proc 76(7):677–687

    Article  PubMed  CAS  Google Scholar 

  10. Sawaya R, Hammoud M, Schoppa D et al (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055

    Article  PubMed  CAS  Google Scholar 

  11. Schulder M, Liang D, Carmel PW (2001) Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager. J Neurosurg 94(6):936–945

    Article  PubMed  CAS  Google Scholar 

  12. Taylor WA, Thomas NW, Wellings JA, Bell BA (1995) Timing of postoperative intracranial hematoma development and implications for the best use of neurosurgical intensive care. J Neurosurg 82(1):48–50

    Article  PubMed  CAS  Google Scholar 

  13. Vives KP, Piepmeier JM (1999) Complications and expected outcome of glioma surgery. J Neurooncol 42(3):289–302

    Article  PubMed  CAS  Google Scholar 

  14. Lassen B, Helseth E, Rønning P et al (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68(5):1259–1268

    PubMed  Google Scholar 

  15. Solheim O, Jakola AS, Gulati S, Johannesen TB (2012) Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study. J Neurosurg 116(4):825–834

    Article  PubMed  Google Scholar 

  16. Patil CG, Veeravagu A, Lad SP, Boakye M (2010) Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the national surgical quality improvement program. J Neurol Neurosurg Psychiatry 81(5):502–505

    Article  PubMed  Google Scholar 

  17. Barker FG 2nd (2004) Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000: decreasing mortality and the effect of provider caseload. Cancer 100(5):999–1007

    Article  PubMed  Google Scholar 

  18. Barker FG 2nd, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988–2000: the effect of provider caseload and centralization of care. Neuro Oncol 7(1):49–63

    Article  PubMed  Google Scholar 

  19. Curry WT, McDermott MW, Carter BS, Barker FG 2nd (2005) Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102(6):977–986

    Article  PubMed  Google Scholar 

  20. Davenport DL, Holsapple CW, Conigliaro J (2009) Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University Health System Consortium Clinical Database and the National Surgical Quality Improvement Program data set. Am J Med Qual 24(5):395–402

    Article  PubMed  Google Scholar 

  21. Devaux BC, O’Fallon JR, Kelly PJ (1993) Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. J Neurosurg 78(6):767–775

    PubMed  CAS  Google Scholar 

  22. Fadul C, Wood J, Thaler H, Galicich J, Patterson RH Jr, Posner JB (1988) Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurology 38(9):1374–1379

    Article  PubMed  CAS  Google Scholar 

  23. Kreth FW, Warnke PC, Scheremet R, Ostertag CB (1993) Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78(5):762–766

    Article  PubMed  CAS  Google Scholar 

  24. Taylor MD, Bernstein M (1999) Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 90(1):35–41

    Article  PubMed  CAS  Google Scholar 

  25. Vorster SJ, Barnett GH (1998) A proposed preoperative grading scheme to assess risk for surgical resection of primary and secondary intraaxial supratentorial brain tumors. Neurosurg Focus 4(6):e2

    Article  PubMed  CAS  Google Scholar 

  26. Black P, Kathiresan S, Chung W (1998) Meningioma surgery in the elderly: a case-control study assessing morbidity and mortality. Acta Neurochir (Wien) 140(10):1013–1016

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kimon Bekelis.

Additional information

Kimon Bekelis and Samuel F. Bakhoum have contributed equally to this study and co-primary authors.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bekelis, K., Bakhoum, S.F., Desai, A. et al. Outcome prediction in intracranial tumor surgery: the National Surgical Quality Improvement Program 2005–2010. J Neurooncol 113, 57–64 (2013). https://doi.org/10.1007/s11060-013-1089-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-013-1089-3

Keywords

Navigation