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Predictors of severe complications in intracranial meningioma surgery: a population-based multicenter study
Jiri Bartek1, Kristin Sjåvik2, Petter Förander3
1Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Objective:
To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events.
Methods:
A retrospective review was conducted in a Scandinavian population-based cohort of 979 adult operations for intracranial meningioma performed at 3 neurosurgical centers with population-based referral between January 1, 2007, and June 30, 2013. Possible predictors of severe complications were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable model.
Results:
Severe complications were observed in 68 (7%) operations. Univariable analyses identified patient age >70 years (P < 0.001), male sex (P = 0.03), Charlson Comorbidity Index >1 (P = 0.02), Simpson grade >3 (P = 0.03), Karnofsky performance scale score <70 (P < 0.001), and duration of surgery >4 hours (P < 0.001) as significant predictors of severe complications. Age >70 (odds ratio = 2.5, P < 0.01), duration of surgery >4 hours (odds ratio = 3.2, P < 0.001), and Karnofsky performance scale score <70 (odds ratio = 2.5, P < 0.01) were independent predictors of severe complications in the multivariable regression analysis.
Conclusions:
Severe complications after meningioma resection are more encountered often in elderly patients (>70 years old), dependent patients (Karnofsky performance scale score <70), and patients who underwent longer lasting surgery (>4 hours). Patient selection, including careful consideration of the individual risk-benefit ratio, is important in improving the safety of intracranial meningioma resection.
Insights
Elderly patients, those with lower functional status, and longer surgeries predict complications after intracranial meningioma resection. Careful patient selection is key to improving safety.
Area of Science:
- Neurosurgery
- Oncology
- Patient Safety
Background:
- Intracranial meningiomas are common primary brain tumors.
- Surgical resection is the primary treatment modality.
- Standardized reporting of adverse events is crucial for outcome analysis.
Purpose of the Study:
- To identify predictors of severe complications following intracranial meningioma resection.
- To analyze factors influencing patient outcomes in a large cohort.
Main Methods:
- Retrospective review of 979 adult operations for intracranial meningioma.
- Analysis of potential predictors in a Scandinavian population-based cohort (2007-2013).
- Univariable and multivariable regression analyses were performed.
Main Results:
- Severe complications occurred in 7% of operations.
- Independent predictors of severe complications included age >70, Karnofsky performance scale score <70, and surgery duration >4 hours.
- Other univariable predictors: male sex, high Charlson Comorbidity Index, and Simpson grade >3.
Conclusions:
- Older age, lower functional status, and prolonged surgery duration are associated with increased severe complications.
- Careful patient selection and risk-benefit assessment are vital for safe meningioma resection.
- Standardized adverse event reporting aids in identifying risk factors.
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