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

Yao-Chung Yang; Yao-Shen Chen; Wei-Chuan Liao; Chun-Hao Yin; Yung-Shang Lin; Meng-Wei Chen; Jin-Shuen Chen

doi:10.1186/s13741-023-00343-x

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

Perioper Med (Lond). 2023 Oct 23;12(1):54. doi: 10.1186/s13741-023-00343-x.

Authors

Yao-Chung Yang^{1

2}, Yao-Shen Chen³, Wei-Chuan Liao¹, Chun-Hao Yin⁴, Yung-Shang Lin¹, Meng-Wei Chen⁵, Jin-Shuen Chen⁶

Affiliations

¹ Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
² Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.
³ Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung City, 81362, Taiwan.
⁴ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan.
⁵ Department of Surgery, Kaohsiung Armed Force General Hospital, Kaohsiung, Taiwan.
⁶ Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung City, 81362, Taiwan. dgschen@vghks.gov.tw.

Abstract

Background: The occurrence of postoperative complications within 30 days (PC1M) of a craniotomy for the removal of a primary malignant brain tumor has been associated with a poor prognosis. However, it is still unclear to early predict the occurrence of PC1M. This study aimed to identify the potential perioperative predictors of PC1M from its preoperative, intraoperative, and 24-h postoperative parameters.

Methods: Patients who had undergone craniotomy for primary malignant brain tumor (World Health Organization grades III and IV) from January 2011 to December 2020 were enrolled from a databank of Kaohsiung Veterans General Hospital, Taiwan. The patients were classified into PC1M and nonPC1M groups. PC1M was defined according to the classification by Landriel et al. as any deviation from an uneventful 30-day postoperative course. In both groups, data regarding the baseline characteristics and perioperative parameters of the patients, including a new marker-kinetic estimated glomerular filtration rate, were collected. Logistic regression was used to analyze the predictability of the perioperative parameters.

Results: The PC1M group included 41 of 95 patients. An American Society of Anesthesiologists score of > 2 (aOR, 3.17; 95% confidence interval [CI], 1.19-8.45; p = 0.021), longer anesthesia duration (aOR, 1.16; 95% CI, 0.69-0.88; p < 0.001), 24-h postoperative change in hematocrit by > - 4.8% (aOR, 3.45; 95% CI, 1.22-9.73; p = 0.0019), and 24-h postoperative change in kinetic estimated glomerular filtration rate of < 0 mL/min (aOR, 3.99; 95% CI, 1.52-10.53; p = 0.005) were identified as independent risk factors for PC1M via stepwise logistic regression analysis. When stratified according to the age of ≥ 65 years (OR, 11.55; 95% CI, 1.30-102.79; p = 0.028), the reduction of kinetic estimated glomerular filtration rate was more robustly associated with a higher risk of PC1M.

Conclusions: Four parameters were demonstrated to significantly influence the risk of PC1M in patients undergoing primary malignant brain tumor removal. Measuring and verifying these markers, especially kinetic estimated glomerular filtration rate, would help early recognition of PC1M risk in clinical care.

Keywords: Glomerular filtration rate; Postoperative complication; Primary malignant brain tumor.

Grants and funding

KSVGH111-050/Kaohsiung Veterans General Hospital