Prognostic factors for lower respiratory tract infections after brain-tumor surgery

Dauch, W. A.; Landau, G.; Krex, D.

doi:10.3171/jns.1989.70.6.0862

Cited by 9 publications

(1 citation statement)

References 42 publications

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“…5,13,19,20,23 Old age itself has been identified as an indicator of a poor prognosis. 6,11,17,22 Studies have also documented high postoperative mortality and morbidity rates in elderly patients with meningiomas and schwannomas, 1,2,21 but in light of the beneficial effects obtained with benign tumor resection, many authors recommend proceeding with surgery in such patients. 14,26,30 Tomita and Raimondi 35 studied 80 elderly patients with brain tumors, including benign tumors, and reported that a total of 27 postoperative systemic complications developed in 23 patients.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative systemic complications in elderly patients with brain tumors

Asano¹,

Nakano²,

Takeda³

et al. 2009

JNS

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Object. In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors.Methods. The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre-and postoperative values), and change in TP level (difference between pre-and postoperative values). The cutoff values for significant independent factors were also determined.Results. Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl.Conclusions. In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre-and postoperative Hb levels are significant risk factors for postoperative systemic complications. (DOI: 10.3171/2008.10.17669) Key WorDs • brain tumor • elderly patient • postoperative systemic complication • risk factorAbbreviations used in this paper: Hb = hemoglobin; KPS = Karnofsky Performance Scale; NYHA = New York Heart Association; PAF = paroxysmal atrial fibrillation; ROC = receiver operating characteristic; TP = total protein. J Neurosurg / Volume 111 / August 2009Risk factors for postoperative systemic complications 259 present study evaluated a wide spectrum of postoperative systemic complications other than neurological deficits, the results should be useful in other fields of surgery. MethodsThe study included 84 patients (41 men and 43 women) 70 years of age or older (mean age 73.7 years), who had undergone surgery under general anesthesia for brain tumor removal between 1994 and 2006. Thirteen patients had malignant astrocytic tumors, 12 had metastatic brain tumors, 30 had meningiomas, 15 had pituitary adenomas, 8 had schwannomas, and 6 had other types of tumors (Table 1). A transsphenoidal sublabial approach was used in the patients with pituitary adenomas, and conventional craniotomy was used in all the other patients. Postoperatively, all patients were treated wi...

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Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative systemic complications in elderly patients with brain tumors

Asano¹,

Nakano²,

Takeda³

et al. 2009

JNS

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The Immunological Status of Brain Tumor Patients

Dauch

Krex

Zeithammer

et al. 1994

Cerebellar Infarct. Midline Tumors. Minimally Invasive Endoscopic Neurosurgery (MIEN)

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Peri-operative changes of cellular and humoral components of immunity with brain tumour surgery

et al. 1994

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Nosocomial infections, which are not uncommon in neurosurgical intensive care medicine, may possibly be favoured by an impairment of immunological competence of the patient. In a prospective observational trial, we investigated several parameters of cellular and humoral immunity in 32 patients before and after resection of an intracranial tumour. We quantified the effects of operative procedure, dexamethasone pretreatment, and tumour type. Dexamethasone alone causes an increase of neutrophilic granulocyte count and monocytes, whereas IgG and eosinophilic granulocytes decrease as well as lymphocytes. CD4+ T lymphocytes (T helper cells) and CD8+ T lymphocytes (T cytotoxic/suppressor cells) were more severely affected than B lymphocytes. Dexamethasone and operation in combination act synergistically on T lymphocytes and IgG, while no synergism is obvious in other clinical test parameters. The skin sensitivity reaction was depressed accordingly. With intracerebral tumours (gliomas WHO grades II to IV), levels of T helper cells and eosinophilic granulocytes were lower, and levels of IgM and neutrophilic granulocytes were higher than with benign extracerebral neoplasms. Postoperative nosocomial infections of the lower respiratory tract occurred almost exclusively in patients subject to severe depression of T helper cells.

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Prognostic factors for lower respiratory tract infections after brain-tumor surgery

Cited by 9 publications

References 42 publications

Risk factors for postoperative systemic complications in elderly patients with brain tumors

Risk factors for postoperative systemic complications in elderly patients with brain tumors

The Immunological Status of Brain Tumor Patients

Peri-operative changes of cellular and humoral components of immunity with brain tumour surgery

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