Ischemic Stroke Risk Among Adult Brain Tumor Survivors: Evidence to Guide Practice

Figuracion, Karl Cristie F; Jung, Wonkyung; Martha, Sarah R

doi:10.1097/jnn.0000000000000606

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…28 However, published data on this topic are sparse and limited to specific tumor and stroke types, reducing the utility of these data in general preoperative decision-making. [29][30][31][32] Previously discovered risk factors for perioperative stroke in neurosurgical patients include diabetes mellitus, ventilator dependence, previous neurological deficits such as hemiparesis and impaired sensorium, and history of stroke. 15,29 The present study adds to existing literature by identifying and quantifying independent risk factors for PCVA and proposing a clinically translatable risk model.…”

Section: Discussionmentioning

confidence: 99%

Preoperative risk model for perioperative stroke after intracranial tumor resection: ACS NSQIP analysis of 30,951 cases

Kassicieh

Rumalla

Kazim

et al. 2022

Neurosurgical Focus

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OBJECTIVE Perioperative and/or postoperative cerebrovascular accidents (PCVAs) after intracranial tumor resection (ITR) are serious complications with devastating effects on quality of life and survival. Here, the authors retrospectively analyzed a prospectively maintained, multicenter surgical registry to design a risk model for PCVA after ITR to support efforts in neurosurgical personalized medicine to risk stratify patients and potentially mitigate poor outcomes. METHODS The National Surgical Quality Improvement Program database was queried for ITR cases (2015–2019, n = 30,951). Patients with and without PCVAs were compared on baseline demographics, preoperative clinical characteristics, and outcomes. Frailty (physiological reserve for surgery) was measured by the Revised Risk Analysis Index (RAI-rev). Logistic regression analysis was performed to identify independent associations between preoperative covariates and PCVA occurrence. The ITR-PCVA risk model was generated based on logit effect sizes and assessed in area under the receiver operating characteristic curve (AUROC) analysis. RESULTS The rate of PCVA was 1.7% (n = 532). Patients with PCVAs, on average, were older and frailer, and had increased rates of nonelective surgery, interhospital transfer status, diabetes, hypertension, unintentional weight loss, and elevated BUN. PCVA was associated with higher rates of postoperative reintubation, infection, thromboembolic events, prolonged length of stay, readmission, reoperation, nonhome discharge destination, and 30-day mortality (all p < 0.001). In multivariable analysis, predictors of PCVAs included RAI “frail” category (OR 1.7, 95% CI 1.2–2.4; p = 0.006), Black (vs White) race (OR 1.5, 95% CI 1.1–2.1; p = 0.009), nonelective surgery (OR 1.4, 95% CI 1.1–1.7; p = 0.003), diabetes mellitus (OR 1.5, 95% CI 1.1–1.9; p = 0.002), hypertension (OR 1.4, 95% CI 1.1–1.7; p = 0.006), and preoperative elevated blood urea nitrogen (OR 1.4, 95% CI 1.1–1.8; p = 0.014). The ITR-PCVA predictive model was proposed from the resultant multivariable analysis and performed with a modest C-statistic in AUROC analysis of 0.64 (95% CI 0.61–0.66). Multicollinearity diagnostics did not detect any correlation between RAI-rev parameters and other covariates (variance inflation factor = 1). CONCLUSIONS The current study proposes a novel preoperative risk model for PCVA in patients undergoing ITR. Patients with poor physiological reserve (measured by frailty), multiple comorbidities, abnormal preoperative laboratory values, and those admitted under high acuity were at highest risk. The ITR-PCVA risk model may support patient-centered counseling striving to respect goals of care and maximize quality of life. Future prospective studies are warranted to validate the ITR-PCVA risk model and evaluate its utility as a bedside clinical tool.

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Section: Discussionmentioning

confidence: 99%

Preoperative risk model for perioperative stroke after intracranial tumor resection: ACS NSQIP analysis of 30,951 cases

Kassicieh

Rumalla

Kazim

et al. 2022

Neurosurgical Focus

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“…68 Health promotion interventions remain critical after treatment in mitigating the risk of stroke. 73,74 Future research is needed to evaluate other mechanisms in the prevention, development, and management of radiation vasculopathy.…”

Section: Radiation-induced Vasculopathymentioning

confidence: 99%

Neurologic Complications in Adult Cancer Survivorship

McGranahan,

Figuracion,

Goldberg

et al. 2024

Semin Neurol

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Over the past decade, the improvement in cancer diagnostics and therapeutics has extended the overall survival of patients diagnosed with cancer including brain cancer. However, despite these unprecedented medical successes, patients continue to experience numerous neurologic complications after treatment that interfere with their independence, functionality, and overall quality of life. These include, among others, cognitive impairment, endocrinopathies, peripheral and cranial neuropathies, and vasculopathy. This article describes the long-term neurologic complications cancer survivors commonly experience to increase awareness of these complications and discuss treatments when available. Further research is necessary to understanding of mechanisms of neurologic injury and advance diagnosis and treatment. Effective patient education, monitoring, and managing neurologic issues after cancer treatment may improve independence, functionality, and quality of life during survivorship.

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“…In every issue of JNN , you will read articles that are highly defined. Among the many articles JNN published last year, there were some very specific topics including: how to reduce stroke risk for adult brain tumor survivors, 1 a Korean stroke-specific quality of life questionnaire, 2 and how Magnet certification is associated with patient safety for persons hospitalized with Parkinson disease 3 . These are super specific, highly defined topics.…”

mentioning

confidence: 99%