Joeky Senders

39 Thirty-day outcomes after craniotomy Reoperation Reoperation also qualifies as a major complication and was the most common major complication in this study. 27 Reoperation is an important indicator of worse clinical outcome recorded in NSQIP and inherently involves increased costs and risks to patients. In this study, ICH was found to be the primary reason for reoperation (18.5% of all patients reoperated within 30 days). Postoperative hemorrhage is one of the most serious complications of any operation on the brain, and is associated with significant morbidity and mortality in addition to that from the original operation and the primary disease. 42,43 ICH is difficult to define and may include bleeding following craniotomy at the operative site or remotely, though this is rare. 44-46 The rates of postoperative ICH following intracranial operations vary greatly throughout the existing literature (0.8-50%). 42,47,48 Hypertension and decreased factor XIII have been identified as factors associated with ICH after brain tumor surgery. 49,50 Interestingly, resection of residual tumor tissue was identified as the third most common cause of reoperation. Improving the extent of resection has gained more attention in recent years, and many complex modalities have been developed and applied intraoperatively to guide and monitor surgical resection, such as stereotactic navigation, intraoperative MRI, ultrasound, functional mapping, and fluorescence guided surgery. 51 The use of these modalities is highly dependent on their availability and the surgeon’s preference; however, they can potentially reduce the rate of short-term reoperations as they find their way to standard clinical practice. Readmission Readmission is a major driver of cost and re-exposes patients to associated risks of long hospital stays. 52,53 The most common causes for readmission following craniotomy for glioma resection were found to be wound related, occurring in 11.9% of readmitted patients. Issues with wound healing, including infection, are known and commonly reported complications of brain tumor resections. 11,15,54,55 Risk factors for wound-related complications include having previously undergone additional craniotomies, additional radiosurgery, or having been treated with the anti-angiogenic factor bevacizumab. 54,56,57 Limitations Limitations of this study are primarily a result of variables not included in the NSQIP dataset, potentially causing underestimation of the total complication and mortality rates for craniotomies. Tumor and surgery specific information, such as histology, grading, size, and location of the tumor as well as the extent of resection have an enormous impact on both short and long-term outcomes; however, these are not