Joeky Senders

24 Chapter 2 Abstract Introduction Despite improved perioperative management, the rate of postoperative morbidity and mortality after brain tumor resection remains considerably high. This study assesses the rates, causes, timing, and predictors of major complication, extended length of stay (>10 days), reoperation, readmission, and death within 30 days after craniotomy for a primary malignant brain tumor. Methods Patients were extracted from the National Surgical Quality Improvement Program registry (2005-2015) and analyzed using multivariable logistic regression. Results 7376 patients were identified, of which 948 (12.9%) experienced a major complication. The most common major complications were reoperation (5.1%), venous thromboembolism (3.5%), and death (2.6%). Furthermore, 15.6% stayed longer than ten days, and 11.5% were readmitted within 30 days after surgery. The most common reasons for reoperation and readmission were intracranial hemorrhage (18.5%) and wound-related complications (11.9%), respectively. Multivariable analysis identified older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA)-classification, dependent functional status, elevated preoperative white blood cell count (WBC, >12,000 cells/mm 3 ), and longer operative time as predictors of major complication (all p<0.001). Higher ASA-classification, dependent functional status, elevated WBC, and ventilator dependence were predictors of extended length of stay (all p<0.001). Higher ASA-classification and elevated WBC were predictors of reoperation (both p<0.001). Higher ASA-classification and dependent functional status were predictors of readmission (both p<0.001). Older age, higher ASA-classification, and dependent functional status were predictors of death (all p<0.001). Conclusion This study provides a descriptive analysis and identifies predictors for short-term complications, including death, after craniotomy for a primary malignant brain tumor.