Patient-Reported Outcomes in Elective Cranial Neurosurgery

The role of patient-reported outcomes (PROs) in elective cranial neurosurgery has been poorly studied, and their significance in reflecting complication rates is unclear.

A prospective, consecutive, and unselected cohort of 418 adult patients underwent elective intracranial operations between 7 December, 2011 and 31 December, 2012 in Helsinki University Hospital, Finland. The questionnaire-based PROs included subjective postoperative assessments of overall health, cognitive function, and subjective change in functional status. Outcome measures included in-hospital major morbidity (including mortality) and in-hospital overall morbidity. We compared the usefulness of PROs with postoperative modified Rankin Scale (mRS) score.

In univariable analyses, all recorded PROs and 30-day mRS scores ≥ 3 were associated with in-hospital major and overall morbidity. After multivariable analyses, postoperative deterioration of subjective functional status remained associated with in-hospital major morbidity (P = 0.001, odds ratio [OR] 4.9, confidence interval [CI] 1.9-12.0, sensitivity 71%, and specificity 70%) and overall in-hospital morbidity (P < 0.001, OR 5.7, CI 3.1-10.7, sensitivity 59%, and specificity 84%). Postoperatively impaired functional status was more sensitive but less specific in detecting in-hospital major and overall morbidity than the widely used mRS cut-off value of 2. A simple composite score combining the 3 recorded PROs was highly sensitive and specific in detecting in-hospital major (sensitivity 87%, specificity 98%) and overall (sensitivity 72%, specificity 99%) morbidity.

In elective craniotomy patients, PROs seem promising patient-centered tools for outcomes reporting. Furthermore, neurosurgery-specific patient-reported outcome measures (PROMs) can perhaps be implemented to clinical use to improve patient safety and outcome comparisons in elective cranial neurosurgery.