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Lenga P, Kleineidam H, Unterberg A, Dao Trong P. Optimizing patient outcome in intracranial tumor surgery: a detailed prospective study of adverse events and mortality reduction strategies in neurosurgery. Acta Neurochir (Wien) 2024; 166:126. [PMID: 38457057 PMCID: PMC10923735 DOI: 10.1007/s00701-024-06008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Brain tumor surgery represents a critical and high-risk area within the field of neurosurgery. Our study aims to offer a comprehensive analysis of adverse events (AEs) from a prospectively maintained database at a leading neurosurgical tertiary center, with a specific focus on different types of tumor entities. METHODS From January 2022 to September 2023, our study focused on adult patients, who underwent surgery for intracranial tumors. Each patient in this demographic was thoroughly assessed for adverse events (AEs) by their attending physicians at discharge. An AE was defined as any event occurring within the first 30 days post-surgery. RESULTS A total of 1173 patients with an average age of 57.4 ± 15.3 years underwent surgical procedures. The majority of these surgeries were elective, accounting for 93.4% (1095 out of 1173), while emergency surgeries constituted 13.9% (163 out of 1173). The incidence of surgery-related AEs was relatively low at 12.7%. The most common surgical indications were meningioma and glioma pathologies, representing 31.1% and 28.2% of cases, respectively. Dural leaks occurred in 1.5% of the cases. Postoperative hemorrhage was a significant complication, especially among glioma patients, with ten experiencing postoperative hemorrhage and eight requiring revision surgery. The overall mortality rate stood at 0.8%, corresponding to five patient deaths. Causes of death included massive postoperative bleeding in one patient, pulmonary embolism in two patients, and tumor progression in two others. CONCLUSIONS Surgical interventions for intracranial neoplasms are inherently associated with a significant risk of adverse events. However, our study's findings reveal a notably low mortality rate within our patient cohort. This suggests that thorough documentation of AEs, coupled with proactive intervention strategies in neurosurgical practices, can substantially enhance patient outcomes.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Medical Faculty of Heidelberg University, Heidelberg, Germany.
| | - Helena Kleineidam
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Medical Faculty of Heidelberg University, Heidelberg, Germany
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Guo ZQ, Xia XY, Cao D, Chen X, He Y, Wang BF, Guo DS, Chen J. A nomogram for predicting the risk of major postoperative complications for patients with meningioma. Neurosurg Rev 2023; 46:288. [PMID: 37907646 DOI: 10.1007/s10143-023-02198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/25/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To identify risk factors for major postoperative complications in meningioma patients and to construct and validate a nomogram that identify patients at high risk of these complications. METHODS The medical records of meningioma patients who underwent surgical resection in our hospital from January 2018 to December 2020 were collected. The patients were divided into a training set (815 cases from the main campus in 2018 and 2019) and a validation set (300 cases from two other campuses in 2020). Major postoperative complications were defined as any new neurological deficits and complications classified as Clavien-Dindo Grading (CDG) II or higher. Univariate and multivariate analyses were conducted using the training set to identify independent risk factors. A nomogram was constructed based on these results. And then validated the nomogram through bootstrap re-sampling in both the training and validation sets. The concordance index (C-index) and the area under the curve (AUC) were used to assess the discriminative ability of the nomogram. The Hosmer-Lemeshow test was performed to evaluate the goodness-of-fit. The optimal cutoff point for the nomogram was calculated using Youden's index. RESULTS In the training set, 135 cases (16.56%) experienced major postoperative complications. The independent risk factors identified were male sex, recurrent tumors, American Society of Anesthesiologists (ASA) class III-IV, preoperative Karnofsky Performance Scale (KPS) score < 80, preoperative serum albumin < 35 g/L, tumor in the skull base or central sulcus area, subtotal tumor resection (STR), allogeneic blood transfusion, and larger tumor size. A nomogram was constructed based on these risk factors. It demonstrated good predictive performance, with a C-index of 0.919 for the training set and 0.872 for the validation set. The area under the curve (AUC) > 0.7 indicated satisfactory discriminative ability. The Hosmer-Lemeshow test showed no significant deviation from the predicted probabilities. And the cutoff for nomogram total points was about 200 (specificity 0.881 and sensitivity 0.834). CONCLUSIONS The constructed nomogram demonstrated robust predictive performance for major postoperative complications in meningioma patients. This model can be used by surgeons as a reference in clinical decision-making.
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Affiliation(s)
- Zheng-Qian Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Yu Xia
- Department of Psychology, Wuchang Hospital, Wuhan, China
| | - Dan Cao
- Department of Neurocritical Care Unit, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xu Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue He
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bao-Feng Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Dong-Sheng Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jian Chen
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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May M, Sedlak V, Pecen L, Priban V, Buchvald P, Fiedler J, Vaverka M, Lipina R, Reguli S, Malik J, Netuka D, Benes V. Role of risk factors, scoring systems, and prognostic models in predicting the functional outcome in meningioma surgery: multicentric study of 552 skull base meningiomas. Neurosurg Rev 2023; 46:124. [PMID: 37219634 PMCID: PMC10205827 DOI: 10.1007/s10143-023-02004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/20/2023] [Accepted: 04/16/2023] [Indexed: 05/24/2023]
Abstract
Despite the importance of functional outcome, only a few scoring systems exist to predict neurologic outcome in meningioma surgery. Therefore, our study aims to identify preoperative risk factors and develop the receiver operating characteristics (ROC) models estimating the risk of a new postoperative neurologic deficit and a decrease in Karnofsky performance status (KPS). A multicentric study was conducted in a cohort of 552 consecutive patients with skull base meningiomas who underwent surgical resection from 2014 to 2019. Data were gathered from clinical, surgical, and pathology records as well as radiological diagnostics. The preoperative predictive factors of functional outcome (neurologic deficit, decrease in KPS) were analyzed in univariate and multivariate stepwise selection analyses. Permanent neurologic deficits were present in 73 (13.2%) patients and a postoperative decrease in KPS in 84 (15.2%). Surgery-related mortality was 1.3%. A ROC model was developed to estimate the probability of a new neurologic deficit (area 0.74; SE 0.0284; 95% Wald confidence limits (0.69; 0.80)) based on meningioma location and diameter. Consequently, a ROC model was developed to predict the probability of a postoperative decrease in KPS (area 0.80; SE 0.0289; 95% Wald confidence limits (0.74; 0.85)) based on the patient's age, meningioma location, diameter, presence of hyperostosis, and dural tail. To ensure an evidence-based therapeutic approach, treatment should be founded on known risk factors, scoring systems, and predictive models. We propose ROC models predicting the functional outcome of skull base meningioma resection based on the age of the patient, meningioma size, and location and the presence of hyperostosis and dural tail.
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Affiliation(s)
- Michaela May
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic.
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Vojtech Sedlak
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Ladislav Pecen
- Institute of Computer Science, The Czech Academy of Sciences, Prague, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, Pilsen University Hospital, Pilsen, Czech Republic
| | - Pavel Buchvald
- Department of Neurosurgery, Liberec Hospital, Liberec, Czech Republic
| | - Jiri Fiedler
- Department of Neurosurgery, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Miroslav Vaverka
- Department of Neurosurgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radim Lipina
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Stefan Reguli
- Department of Neurosurgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jozef Malik
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, U Vojenske nemocnice 1200, 16902, Prague, Czech Republic
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Henriksen KA, Von Oettingen G, Skjøth-Rasmussen J, Mathiasen R, Foss-Skiftesvik J. Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery. Childs Nerv Syst 2023:10.1007/s00381-023-05902-7. [PMID: 36877208 DOI: 10.1007/s00381-023-05902-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To assess the performance of the risk-predicting Milan Complexity Scale (MCS) on postoperative morbidity in pediatric neuro-oncological surgery. METHODS A retrospective dual-center review of children undergoing primary brain tumor resection in Denmark over a 10-year period. MCS scoring was performed based on preoperative imaging, blinded to individual outcomes. Surgical morbidity was registered according to existing complication scales and dichotomized as significant or nonsignificant morbidity. The MCS was evaluated using logistic regression modeling. RESULTS 208 children (50% female, mean age 7.9 y, and SD 5.2) were included. Of the original "Big Five" predictors included in the MCS, only posterior fossa (OR: 2.31, 95% CI: 1.25-4.34, p-value = 0.008) and eloquent area (OR: 3.32, 95% CI: 1.50-7.68, p-value = 0.004) locations were significantly associated with increased risk of significant morbidity in our pediatric cohort. The absolute MCS score correctly classified 63.0% of cases. Its accuracy increased to 69.2% when mutually adjusting for each of the "Big Five" predictors with corresponding positive and negative predictive values of 66.2% and 71.0%, using a predicted probability cutoff of 0.5. CONCLUSION The MCS is predictive of postoperative morbidity also in pediatric neuro-oncological surgery, although only two of its original five variables were significantly associated with poor outcome in children. The clinical value of the MCS is likely limited for the experienced pediatric neurosurgeon. Future clinically impactful risk-prediction tools should include a larger number of relevant variables and be tailored to the pediatric population.
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Affiliation(s)
- Kasper Amund Henriksen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jane Skjøth-Rasmussen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurosurgery, Rigshospitalet University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jon Foss-Skiftesvik
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark. .,Department of Neurosurgery, Rigshospitalet University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark.
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Chen L, Rao S, Fan S, Pan C, Liu M, Yi L, Guo J. Effect of care intervention based on susceptible pointers of care quality in patients with hepatic cerebropathy. Am J Transl Res 2022; 14:4082-4089. [PMID: 35836888 PMCID: PMC9274580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the effect of care intervention based on susceptible pointers of care quality in patients with hepatic cerebropathy. METHODS The clinical data of 106 patients with hepatic cerebropathy from January 2020 to June 2021 were retrospectively analyzed, and they were assigned to a study group (n=53) or a control group (n=53) in line with diverse care means. The control group received conventional care, and the study group received additional care intervention based on susceptible pointers of care quality. The liver function, blood ammonia, neural function, capacity of daily life, and quality of life were observed and contrasted in the two groups before and after the intervention. The implementation or occurrence of key indicators of care quality, the occurrence of adverse care events, and patient care satisfaction rate were documented in the two groups after intervention. RESULTS After the intervention, the liver function, neural function, capacity of everyday activities, quality of life and the implementation or occurrence of key pointers of care quality in the study group were superior to those in the control group (P<0.05). The blood ammonia and the incidence of adverse events in the study group were lower than those of the control group (P<0.05), and the care satisfaction rate of patients in the study group was higher than that of the control group (P<0.05). CONCLUSION Care intervention based on susceptible pointers of care quality can help patients with hepatic cerebropathy to enhance liver and neural function, decrease blood ammonia and have fewer adverse care events, and enhances quality of life, care quality, and care satisfaction of patients.
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Affiliation(s)
- Lina Chen
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
| | - Suyu Rao
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
| | - Shuyu Fan
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
| | - Chenwei Pan
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
| | - Minou Liu
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
| | - Liyun Yi
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
| | - Junyi Guo
- Department of Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou 325027, Zhejiang, China
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Sarnthein J, Staartjes VE, Regli L. Neurosurgery outcomes and complications in a monocentric 7-year patient registry. BRAIN & SPINE 2022; 2:100860. [PMID: 36248111 PMCID: PMC9560692 DOI: 10.1016/j.bas.2022.100860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/02/2022] [Accepted: 01/08/2022] [Indexed: 12/11/2022]
Abstract
Introduction Capturing adverse events reliably is paramount for clinical practice and research alike. In the era of "big data", prospective registries form the basis of clinical research and quality improvement. Research question To present results of long-term implementation of a prospective patient registry, and evaluate the validity of the Clavien-Dindo grade (CDG) to classify complications in neurosurgery. Materials and methods A prospective registry for cranial and spinal neurosurgical procedures was implemented in 2013. The CDG - a complication grading focused on need for unplanned therapeutic intervention - was used to grade complications. We assess construct validity of the CDG. Results Data acquisition integrated into our hospital workflow permitted to include all eligible patients into the registry. We have registered 8226 patients that were treated in 11994 surgeries and 32494 consultations up until December 2020. Similarly, we have captured 1245 complications on 6308 patient discharge forms (20%) since full operational status of the registry. The majority of complications (819/6308 = 13%) were treated without invasive treatment (CDG 1 or CDG 2). At discharge, there was a clear correlation of CDG and the Karnofsky Performance Status (KPS, rho = -0.29, slope -7 KPS percentage points per increment of CDG) and the length of stay (rho = 0.43, slope 3.2 days per increment of CDG). Discussion and conclusion Patient registries with high completeness and objective capturing of complications are central to the process of quality improvement. The CDG demonstrates construct validity as a measure of complication classification in a neurosurgical patient population.
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Affiliation(s)
- Johannes Sarnthein
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Switzerland
| | - Victor E. Staartjes
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Switzerland
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