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Paper title The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors
Paper code P22
Authors
  1. Martin N. Stienen Universitätsspital Zürich Speaker
  2. David Y. Zhang Universitätsspital Zürich
  3. Morgan Broggi Fondazione IRCCS Istituto Neurologico Carlo Besta
  4. Dominik Seggewiss Charité - Universitätsmedizin Berlin
  5. Stefano Villa Fondazione IRCCS Istituto Neurologico Carlo Besta
  6. Silvia Schiavolin Fondazione IRCCS Istituto Neurologico Carlo Besta
  7. Oliver Bozinov Kantonsspital St. Gallen
  8. Niklaus Krayenbühl Universitätsspital Zürich
  9. Johannes Sarnthein Universitätsspital Zürich
  10. Paolo Ferroli Fondazione IRCCS Istituto Neurologico Carlo Besta
  11. Luca Regli University Hospital of Zurich
Form of presentation Poster
Topics
  • SSNS-Neurosurgery
Abstract text Aim: The decision whether to operate on patients with intracranial tumors is complex and influenced by patient-specific factors, including the preoperative functional status. It was our objective to assess risks for mortality and complications, and post-operative recovery in functionally dependent patients undergoing microsurgical resection of intracranial tumors.
Methods: Observational two-center study, analyzing institutional registry data. Dependency was defined as admission Karnofsky Performance Scale (KPS) of ≤ 50. The primary endpoint was in-hospital mortality. Secondary endpoints were rate and type (Clavien-Dindo grade (CDG)) of complications, as well as postoperative change in KPS until the 3-month follow-up (M3).
Results: Of n=1951 patients, n=98 (5.0%) were dependent. Mortality rates were 2.0% for dependent and 0.4% for independent patients (p=0.018). In univariate analysis, dependent patients were more likely than independent patients to die in hospital (OR 5.49, 95% CI 1.12-26.8, p=0.035). In a multivariate model, the effect was slightly attenuated (OR 4.75, 95% CI 0.91-24.7, p=0.064). Dependent patients tended to experience more postoperative complications. They were more likely to suffer from a severe complication (CDG 4&5; OR 3.55, 95% CI 1.49-8.46, p=0.004). In 40.8% and 52.4% of cases, dependent patients regained functional independence at discharge and M3, respectively.
Conclusions: In operated patients with intracranial tumors presenting functionally dependent at admission, the risk for in-hospital mortality and complications is elevated. However, if conducted successfully, surgery may lead to regain of independence in every second patient within three months.