Influence on morbidity and mortality of neoadjuvant radiation and chemotherapy among cranial malignancy patients in the postoperative setting

Hein, Paul N.; Lieber, Bryan; Bruce, Eliza; Taylor, Brittany L.; Appelboom, Geoffrey; Abraham, Mickey; Connolly, E. Sander

doi:10.1016/j.jocn.2015.01.005

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…All rights reserved. Gland Surg 2017;6(1):14-26 gs.amegroups.com complication type, agents used, and whether radiation was delivered preoperatively (6)(7)(8)(9)13,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Findings also vary between studies of the same organ ( Table 1) (6)(7)(8)(9)(10)(11)(12)37).…”

Section: Discussionmentioning

confidence: 99%

“…Findings also vary between studies of the same organ ( Table 1) (6)(7)(8)(9)(10)(11)(12)37). In some reports of organ sites other than breast, NAC was associated with increased transfusions, readmissions, SSI, stroke, and mortality (13,15,21,22,24,25). In other reports, NAC was not associated with any complication (13)(14)(15)(16)(17)(18)(19)(20)(21)23,25).…”

Section: Discussionmentioning

confidence: 99%

“…In some reports of organ sites other than breast, NAC was associated with increased transfusions, readmissions, SSI, stroke, and mortality (13,15,21,22,24,25). In other reports, NAC was not associated with any complication (13)(14)(15)(16)(17)(18)(19)(20)(21)23,25). Given this variability, our primary objective was to clarify the association between NAC and non-oncologic postoperative outcomes in patients undergoing breast surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the smaller number of patient encounters, single-institution reports of the effect of NAC on postoperative complications after breast surgery are more limited in their ability to distinguish differences in complications attributed to NAC (10)(11)(12). The association of NAC with morbidity and mortality (M&M) for organ sites other than breast has been reported many times (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), but these reports may not be relevant for breast patients. For example, patients undergoing breast surgery have lower overall M&M but higher reoperation rates compared with most other general surgical oncology operations (27)(28)(29).…”

Section: Original Articlementioning

confidence: 99%

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Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Landercasper¹,

Bennie²,

Bray³

et al. 2017

Gland Surg.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

See 2 more Smart Citations

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Landercasper¹,

Bennie²,

Bray³

et al. 2017

Gland Surg.

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show abstract

“…Patients enrolled in the NSQIP are followed for 30 days postoperatively, and all complications (among those collected in the NSQIP algorithm) that occurred during this period are recorded; there is no administrative censoring or loss to follow-up of patients entered. The accuracy of data collection by the NSQIP (including cumulative incidence and reasons for readmission) has been externally validated, 84 and this data source has been previously used to evaluate patients undergoing neurosurgical intervention, 4,8,12,14,15,28,29,45,54,83 including spine surgery. 2,6,9,10,25,40,53,59,61,82,91 Our institutional review board has exempted the de-identified NSQIP data set from individual review.…”

Section: Data Sourcementioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

100

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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Impact of operative length on post-operative complications in meningioma surgery: a NSQIP analysis

et al. 2016

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Many studies have implicated operative length as a predictor of post-operative complications, including venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)]. We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, to evaluate whether length of operation had a statistically significant effect on post-operative complications in patients undergoing surgical resection of meningioma. Patients were included for this study if they had a post-operative diagnosis of meningioma. Patient demographics, pre-operative comorbidities, and post-operative 30-day complications were analyzed. Of 3743 patients undergoing craniotomy for meningioma, 13.6 % experienced any complication. The most common complications and their median time to occurrence were urinary tract infection (2.6 %) at 10 days postoperatively (IQR 7-15), unplanned intubation (2.5 %) at 3 days (IQR 1-7), failure to wean from ventilator (2.4 %) at 2.0 days (IQR 2-4), and DVT (2.4 %) at 6 days (IQR 11-19). Postoperatively, 3.6 % developed VTE; 2.4 % developed DVT and 1.7 % developed PE. Multivariable analysis identified older age (third and upper quartile), obesity, preoperative ventilator dependence, preoperative steroid use, anemia, and longer operative time as significant risk factors for VTE. Separate multivariable logistic regression models demonstrated longer operative time as a significant risk factor for VTE, all complications, major complications, and minor complications. Meningioma resection is associated with various post-operative complications that increase patient morbidity and mortality risk. this large, multi-institutional patient sample, longer operative length was associated with increased risk for postoperative venous thromboembolisms, as well as major and minor complications.

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Influence on morbidity and mortality of neoadjuvant radiation and chemotherapy among cranial malignancy patients in the postoperative setting

Cited by 10 publications

References 24 publications

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Impact of operative length on post-operative complications in meningioma surgery: a NSQIP analysis

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