Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma

Abstract

BACKGROUND Extent of resection (EOR) is well established as correlating with overall survival in patients with glioblastoma (GBM). The impact of EOR on reported quality metrics such as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) is unknown. OBJECTIVE To perform a retrospective study to evaluate possible associations between EOR and the incidence of PSIs and HACs. METHODS We queried all patients diagnosed with GBM who underwent surgical resection at our institution between January 2011 and May 2017. Pre- and postoperative magnetic resonance images were analyzed for EOR. Each chart was reviewed to determine the incidence of PSIs and HACs. RESULTS A total of 284 patients met the inclusion criteria. EOR ranged from 39.00 to 100%, with a median of 99.84% and a mean of 95.7%. There were 16 PSI, and 13 HAC, events. There were no significant differences in the rates of PSIs or HACs when compared between patients stratified by gross total resection (EOR ≥ 95%) and subtotal resection (EOR < 95%). The odds of encountering a PSI or HAC were 2.5 times more likely in the subtotal resection group compared to the gross total resection group (P = .58). After adjusting for confounders, the odds of encountering a PSI or HAC in the subtotal resection group were 3.9 times greater than for the gross total resection group (P < .05). CONCLUSION Gross total resection of GBM is associated with a decreased incidence of PSIs and HACs, as compared to subtotal resection.

Safety metric profiling in surgery for temporal glioblastoma: lobectomy as a supra-total resection regime preserves perioperative standard quality rates

“…The overall morbidity rate was found to reach about 16%. Thereby, the quantitative complication level in our series was in accordance to existent literature where respective values on overall complications in glioblastoma surgery are given between 11 and 32% [ 16 , 21 – 23 ]. It is important to mention that a PSI- and HAC-based assessment of postoperative unfavorable events will also cover transient events like catheter-associated urinary tract infections and therefore will quantitatively surpass complication levels of several previous studies that focused exclusively on postoperative events which required further surgical treatment [ 21 , 24 , 25 ].…”

“…Thereby, the quantitative complication level in our series was in accordance to existent literature where respective values on overall complications in glioblastoma surgery are given between 11 and 32% [ 16 , 21 – 23 ]. It is important to mention that a PSI- and HAC-based assessment of postoperative unfavorable events will also cover transient events like catheter-associated urinary tract infections and therefore will quantitatively surpass complication levels of several previous studies that focused exclusively on postoperative events which required further surgical treatment [ 21 , 24 , 25 ]. Further, postoperative secondary hemorrhage and urinary tract infection were identified as the most common unfavorable events within the presented patient cohort of selected temporal glioblastoma disease and observed levels of incidence met previously reported data [ 26 – 28 ].…”

Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage

“…[12] Beyond its effect on patient morbidity and mortality, these events are now tracked by regulatory agencies such as the Agency of Healthcare Research and Quality and the Center for Medicare and Medicaid Services as a quality metric to serve as a point of comparison between clinicians and between hospitals. [20] Annual costs related to VTE are estimated to be upwards of 30 billion dollars. [7] Early mobilization, the use of intermittent pneumatic compression devices and chemoprophylaxis is accepted measures to reduce the occurrence of DVT/PE.…”

Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults

“…Despite tumor location within eloquent brain areas and despite aggressive resections, postoperative complications were lower and neurological outcomes were better following awake resections compared to asleep resections. Previous studies have reported that a greater extent of resection was associated with a lower rate of postoperative complications in glioblastomas [41,49,50] and described the correlation between awake craniotomy and function preservation in series of diffuse gliomas located within eloquent brain areas [51][52][53]. Clavreul et al, showed a correlation between incomplete resection and postoperative neurological deficits in a series of glioblastomas resected under awake craniotomy [42].…”