Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latinoamerican hospital

Abstract 

Background

There are not many studies that address the selection of patients harboring malignant brain tumors for open surgery. It is necessary, especially in developing countries, to establish the standards because of their impact not only on the efficacy but also on the cost-effectiveness of surgery. With the concern to add information that may help in future studies about the decision making, we proposed to analyze factors associated with surgical complications and evaluate their influence on the functional status at 30 days after surgery.

Methods

A consecutive series of 236 surgeries performed between June 1999 and June 2005 were retrospectively analyzed (168 gliomas, 65 metastases, 3 others). Variables evaluated were age, sex, pre- and postoperative KPS, ASA status, anatomic localization, extent of tumor resection, tumor histology, and number of surgeries.

Results

The incidence of complicated craniotomies was 15.68% and mortality was 2.97%. Postoperatively, 92% of the patients improved or maintained the functional status, whereas 8% worsened. In multivariate analysis, only preoperative KPS (P = .009), ASA status (P = .02), and histology type (P = .03) showed significant association with postoperative complications.

Conclusions

We found that the neurologic and clinical preoperative condition and grade III gliomas were factors related to postoperative complications, whereas age, extent of resection, and number of surgeries were not risk factors. We believe that these conclusions provide an additional benchmark for future multicentric studies that focus on the selection criteria for resection of malignant brain tumors.

Abbreviations: ASA status, American Society of Anesthesiologists' physical status classification for anaesthetic/surgical risk, CI, confidence interval, CSF, cerebrospinal fluid, ICU, intensive care unit, KPS, Karnofsky performance status, LOS, length of stay, MR, magnetic resonance, NA, not applicable, OR, odds ratio, WHO, World Health Organization

Keywords: Craniotomy, Karnofsky performance status, Malignant brain tumor, Postoperative complications