Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study

Abstract

Although considered surgically related if they occur within the first 30 days of surgery, most early postoperative deaths can happen independent of the handiwork of the operating surgeon or anesthesiologist. Overall prognosis of the disease seems to be a strong predictor of perioperative death-perhaps not surprisingly since the 30-day mortality rate is merely the intonation of the Kaplan-Meier curve. Both referral and treatment policies at a neurosurgical center will therefore markedly affect such early outcomes, but early deaths may not necessarily reflect overall quality of care or long-term results. The low incidence of perioperative death in intracranial tumor surgery also greatly limits the statistical power in comparative analyses, such as between published patient series or between centers and certainly between surgeons. Therefore the authors question the value of perioperative mortality rates as a quality indicator in modern neurosurgery for tumors.

The Evangelismos hospital central nervous system tumor registry: Analysis of 1414 cases (1998-2009)

“…This finding appears consistent with previous evidence indicating that advanced age has an adverse effects on neurosurgical mortality rates in tumor patients. [410293340] Nevertheless, it should be noted that age alone cannot be safely used as a selection criterion for surgery. [3739] While beyond the scope of the present analysis, future studies incorporating adjustments for factors such as tumor size/location and histological characteristics, preoperative neurological, and physical status, co-morbidities[6363840] are warranted.…”

Outcome prediction in intracranial tumor surgery: the National Surgical Quality Improvement Program 2005–2010

“…Most of these have been retrospective analyses of single institution experiences 3-13 , demonstrating results with limited generalization given their inherent selection bias. The interpretation of other multi-center studies is equally limited given their focus on regional 14,15 or subgroup data 2,16 , and administrative registries 17-19 . The latter have been heavily criticized for not been independently validated and underreporting patient comorbidities and procedural complications.…”

Craniotomy for Glioma Resection: A Predictive Model

“…The generalization of these findings is limited given their single institution, retrospective nature (6-8, 11, 13, 20, 22-24, 28, 30). Other regional analyses can be affected by selection bias (19,25). Prior work on the National Surgical Quality Improvement Program (NSQIP) (4) has demonstrated the creation of an initial predictive model of complications for patients undergoing craniotomies for tumor resection.…”