Top

Published in:

01-02-2019 | Nosocomial Infection | Original Article - Brain Tumors

Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics

Authors: Stephanie Schipmann, Tobias Brix, Julian Varghese, Nils Warneke, Michael Schwake, Benjamin Brokinkel, Christian Ewelt, Martin Dugas, Walter Stummer

Published in: Acta Neurochirurgica | Issue 2/2019

Abstract

Background

The aim of the study was to determine pre-operative factors associated with adverse events occurring within 30 days after neurosurgical tumor treatment in a German center, adjusting for their incidence in order to prospectively compare different centers.

Methods

Adult patients that were hospitalized due to a benign or malignant brain were retrospectively assessed for quality indicators and adverse events. Analyses were performed in order to determine risk factors for adverse events and reasons for readmission and reoperation.

Results

A total of 2511 cases were enrolled. The 30 days unplanned readmission rate to the same hospital was 5.7%. The main reason for readmission was tumor progression. Every 10th patient had an unplanned reoperation. The incidence of surgical revisions due to infections was 2.3%. Taking together all monitored adverse events, male patients had a higher risk for any of these complications (OR 1.236, 95%CI 1.025–1.490, p = 0.027). Age, sex, and histological diagnosis were predictors of experiencing any complication. Adjusted by incidence, the increased risk ratios greater than 10.0% were found for male sex, age, metastatic tumor, and hemiplegia for various quality indicators.

Conclusions

We found that most predictors of outcome rates are based on preoperative underlying medical conditions and are not modifiable by the surgeon. Comparing our results to the literature, we conclude that differences in readmission and reoperation rates are strongly influenced by standards in decision making and that comparison of outcome rates between different health-care providers on an international basis is challenging. Each health-care system has to develop own metrics for risk adjustment that require regular reassessment.

Available only for authorised users

Agarwal R, Mohapatra S, Rath GP, Kapil A (2017) Active surveillance of health care associated infections in neurosurgical patients. J Clin Diagn Res 11:DC01–DC04. https://doi.org/10.7860/JCDR/2017/26681.10146 CrossRefPubMedPubMedCentral

Algattas H, Kimmell KT, Vates GE (2016) Risk of reoperation for hemorrhage in patients after craniotomy. World Neurosurg 87:531–539. https://doi.org/10.1016/j.wneu.2015.09.020 CrossRefPubMed

Ansari SF, Yan H, Zou J, Worth RM, Barbaro NM (2018) Hospital length of stay and readmission rate for neurosurgical patients. Neurosurgery 82:173–181. https://doi.org/10.1093/neuros/nyx160 CrossRefPubMed

Barami K, Fernandes R (2012) Incidence, risk factors and management of delayed wound dehiscence after craniotomy for tumor resection. J Clin Neurosci 19:854–857. https://doi.org/10.1016/j.jocn.2011.09.025 CrossRefPubMed

Birkmeyer JD, Dimick JB, Birkmeyer NJ (2004) Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg 198:626–632. https://doi.org/10.1016/j.jamcollsurg.2003.11.017 CrossRefPubMed

Buchanan CC, Hernandez EA, Anderson JM, Dye JA, Leung M, Buxey F, Bergsneider M, Afsar-Manesh N, Pouratian N, Martin NA (2014) Analysis of 30-day readmissions among neurosurgical patients: surgical complication avoidance as key to quality improvement. J Neurosurg 121:170–175. https://doi.org/10.3171/2014.4.JNS13944 CrossRefPubMed

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed

Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251CrossRefPubMed

Dasenbrock HH, Liu KX, Devine CA, Chavakula V, Smith TR, Gormley WB, Dunn IF (2015) Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Neurosurg Focus 39:E12. https://doi.org/10.3171/2015.10.FOCUS15386 CrossRefPubMed

10.

Dasenbrock HH, Devine CA, Liu KX, Gormley WB, Claus EB, Smith TR, Dunn IF (2016) Thrombocytopenia and craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Cancer 122:1708–1717. https://doi.org/10.1002/cncr.29984 CrossRefPubMed

11.

Dasenbrock HH, Yan SC, Chavakula V, Gormley WB, Smith TR, Claus EB, Dunn IF (2017) Unplanned reoperation after craniotomy for tumor: a National Surgical Quality Improvement Program Analysis. Neurosurgery 81:761–771. https://doi.org/10.1093/neuros/nyx089 CrossRefPubMed

12.

Dasenbrock HH, Yan SC, Smith TR, Valdes PA, Gormley WB, Claus EB, Dunn IF (2017) Readmission after craniotomy for tumor: a National Surgical Quality Improvement Program Analysis. Neurosurgery 80:551–562. https://doi.org/10.1093/neuros/nyw062 CrossRefPubMed

13.

Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, Stiefel MF, Park MS, Bambakidis NC (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24:E10. https://doi.org/10.3171/FOC/2008/24/6/E10 CrossRefPubMed

14.

Dickinson H, Carico C, Nuno M, Mukherjee D, Ortega A, Black KL, Patil CG (2015) Unplanned readmissions and survival following brain tumor surgery. J Neurosurg 122:61–68. https://doi.org/10.3171/2014.8.JNS1498 CrossRefPubMed

15.

Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA Jr (2004) Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 199:531–537. https://doi.org/10.1016/j.jamcollsurg.2004.05.276 CrossRefPubMed

16.

Donoho DA, Wen T, Babadjouni RM, Schwartzman W, Buchanan IA, Cen SY, Zada G, Mack WJ, Attenello FJ (2018) Predictors of 30- and 90-day readmission following craniotomy for malignant brain tumors: analysis of nationwide data. J Neuro-Oncol 136:87–94. https://doi.org/10.1007/s11060-017-2625-3 CrossRef

17.

Fukamachi A, Koizumi H, Nukui H (1985) Postoperative intracerebral hemorrhages: a survey of computed tomographic findings after 1074 intracranial operations. Surg Neurol 23:575–580CrossRefPubMed

18.

Gerlach R, Raabe A, Scharrer I, Meixensberger J, Seifert V (2004) Post-operative hematoma after surgery for intracranial meningiomas: causes, avoidable risk factors and clinical outcome. Neurol Res 26:61–66. https://doi.org/10.1179/016164104773026543 CrossRefPubMed

19.

Hardesty DA, Sanai N (2012) The value of glioma extent of resection in the modern neurosurgical era. Front Neurol 3:140. https://doi.org/10.3389/fneur.2012.00140 CrossRefPubMedPubMedCentral

20.

Houkin K, Baba T, Minamida Y, Nonaka T, Koyanagi I, Iiboshi S (2009) Quantitative analysis of adverse events in neurosurgery. Neurosurgery 65:587–594; discussion 594. https://doi.org/10.1227/01.NEU.0000350860.59902.68 CrossRefPubMed

21.

Ivanovic J, Seely AJ, Anstee C, Villeneuve PJ, Gilbert S, Maziak DE, Shamji FM, Forster AJ, Sundaresan RS (2014) Measuring surgical quality: comparison of postoperative adverse events with the American College of Surgeons NSQIP and the thoracic morbidity and mortality classification system. J Am Coll Surg 218:1024–1031. https://doi.org/10.1016/j.jamcollsurg.2013.12.043 CrossRefPubMed

22.

Kageji T, Nagahiro S, Mizobuchi Y, Nakajima K (2017) Postoperative hematoma requiring Recraniotomy in 1149 consecutive patients with intracranial tumors. Oper Neurosurg (Hagerstown) 13:392–397. https://doi.org/10.1093/ons/opw045 CrossRef

23.

Kalfas IH, Little JR (1988) Postoperative hemorrhage: a survey of 4992 intracranial procedures. Neurosurgery 23:343–347CrossRefPubMed

24.

Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple JF (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA surgical quality improvement program. Ann Surg 228:491–507CrossRefPubMedPubMedCentral

25.

Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19:155–162. https://doi.org/10.1080/02688690500145639 CrossRefPubMed

26.

Lassen B, Helseth E, Ronning P, Scheie D, Johannesen TB, Maehlen J, Langmoen IA, Meling TR (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68:1259–1268; discussion 1268-1259. https://doi.org/10.1227/NEU.0b013e31820c0441 CrossRefPubMed

27.

Levin ML (1953) The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum 9:531–541PubMed

28.

Marcus LP, McCutcheon BA, Noorbakhsh A, Parina RP, Gonda DD, Chen C, Chang DC, Carter BS (2014) Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010). J Neurosurg 120:1201–1211. https://doi.org/10.3171/2014.1.JNS131264 CrossRefPubMed

29.

McCutcheon BA, Ubl DS, Babu M, Maloney P, Murphy M, Kerezoudis P, Bydon M, Habermann EB, Parney I (2016) Predictors of surgical site infection following craniotomy for intracranial neoplasms: an analysis of prospectively collected data in the American College of Surgeons National Surgical Quality Improvement Program Database. World Neurosurg 88:350–358. https://doi.org/10.1016/j.wneu.2015.12.068 CrossRefPubMed

30.

McLaughlin N, Jin P, Martin NA (2015) Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement. J Neurosurg 123:198–205. https://doi.org/10.3171/2014.9.JNS14666 CrossRefPubMed

31.

Moghavem N, Morrison D, Ratliff JK, Hernandez-Boussard T (2015) Cranial neurosurgical 30-day readmissions by clinical indication. J Neurosurg 123:189–197. https://doi.org/10.3171/2014.12.JNS14447 CrossRefPubMed

32.

Morokoff AP, Zauberman J, Black PM (2008) Surgery for convexity meningiomas. Neurosurgery 63:427–433; discussion 433-424. https://doi.org/10.1227/01.NEU.0000310692.80289.28 CrossRefPubMed

33.

Nuno M, Ly D, Ortega A, Sarmiento JM, Mukherjee D, Black KL, Patil CG (2014) Does 30-day readmission affect long-term outcome among glioblastoma patients? Neurosurgery 74:196–204; discussion 204-195. https://doi.org/10.1227/NEU.0000000000000243 CrossRefPubMed

34.

Palmer JD, Sparrow OC, Iannotti F (1994) Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 35:1061–1064 discussion 1064-1065 CrossRefPubMed

35.

Ren Y, Zheng J, Liu X, Li H, You C (2018) Risk factors of rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage: a case-control study. J Korean Neurosurg Soc 61:35–41. https://doi.org/10.3340/jkns.2017.0199 CrossRefPubMed

36.

Sainani KL (2011) Understanding odds ratios. PM R 3:263–267. https://doi.org/10.1016/j.pmrj.2011.01.009 CrossRefPubMed

37.

Schipmann S, Akalin E, Doods J, Ewelt C, Stummer W, Suero Molina E (2016) When the infection hits the wound: matched case-control study in a neurosurgical patient collective including systematic literature review and risk factors analysis. World Neurosurg 95:178–189. https://doi.org/10.1016/j.wneu.2016.07.093 CrossRefPubMed

38.

Schipmann S, Schwake M, Suero Molina E, Roeder N, Steudel WI, Warneke N, Stummer W (2017) Quality indicators in cranial neurosurgery: which are presently substantiated? A systematic review. World Neurosurg 104:104–112. https://doi.org/10.1016/j.wneu.2017.03.111 CrossRefPubMed

39.

Senders JT, Muskens IS, Cote DJ, Goldhaber NH, Dawood HY, Gormley WB, Broekman MLD, Smith TR (2018) Thirty-day outcomes after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program Analysis. Neurosurgery. https://doi.org/10.1093/neuros/nyy001

40.

Shah MN, Stoev IT, Sanford DE, Gao F, Santiago P, Jaques DP, Dacey RG Jr (2013) Are readmission rates on a neurosurgical service indicators of quality of care? J Neurosurg 119:1043–1049. https://doi.org/10.3171/2013.3.JNS121769 CrossRefPubMedPubMedCentral

41.

Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T, Group AL-GS (2008) Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 62:564–576; discussion 564-576. https://doi.org/10.1227/01.neu.0000317304.31579.17 CrossRefPubMed

42.

Taylor BE, Youngerman BE, Goldstein H, Kabat DH, Appelboom G, Gold WE, Connolly ES Jr (2016) Causes and timing of unplanned early readmission after neurosurgery. Neurosurgery 79:356–369. https://doi.org/10.1227/NEU.0000000000001110 CrossRefPubMed

43.

Wang AS, Armstrong EJ, Armstrong AW (2013) Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg 206:410–417. https://doi.org/10.1016/j.amjsurg.2012.11.018 CrossRefPubMed

44.

Wolters U, Wolf T, Stutzer H, Schroder T (1996) ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 77:217–222CrossRefPubMed

45.

Zegers M, de Bruijne MC, de Keizer B, Merten H, Groenewegen PP, van der Wal G, Wagner C (2011) The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Saf Surg 5:13. https://doi.org/10.1186/1754-9493-5-13 CrossRefPubMedPubMedCentral

46.

Zhang J, Yu KF (1998) What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280:1690–1691CrossRefPubMed

Title: Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics
Authors: Stephanie Schipmann
Tobias Brix
Julian Varghese
Nils Warneke
Michael Schwake
Benjamin Brokinkel
Christian Ewelt
Martin Dugas
Walter Stummer
Publication date: 01-02-2019
Publisher: Springer Vienna
Keywords: Nosocomial Infection
Meningioma
Meningioma
Brain Tumor
Hemiplegia
Published in: Acta Neurochirurgica / Issue 2/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-018-03790-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Adverse events in brain tumor surgery: incidence, type, and impact on current quality metrics

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury

Neuroendoscopy—a minimally invasive alternative in the surgical management of traumatic intracerebral contusions?

Post-partum posterior reversible encephalopathy syndrome requiring decompressive craniectomy: case report and review of the literature

Statin use in patients undergoing carotid artery endarterectomy: still much to be uncovered

Treatment and survival of osteosarcoma and Ewing sarcoma of the skull: a SEER database analysis

Efficiency and complications of Woven EndoBridge (WEB) devices for treatment of larger, complex intracranial aneurysms—a single-center experience