Journal Article

Unplanned Reoperation After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis

Chavakula, Vamsi, Smith, Timothy R, Claus, Elizabeth B, Gormley, William B, Dasenbrock, Hormuzdiyar H, Yan, Sandra C, Dunn, Ian F

2017

Overview

Abstract BACKGROUND Reoperation has been increasingly utilized as a metric evaluating quality of care. OBJECTIVE To evaluate the rate of, reasons for, and predictors of unplanned reoperation after craniotomy for tumor in a nationally accrued population. METHODS Patients who underwent cranial tumor resection were extracted from the prospective National Surgical Quality Improvement Program registry (2012-2014). Multivariate logistic regression examined predictors of unplanned cranial reoperation. Predictors screened included patient age, sex, tumor location and histology, functional status, comorbidities, preoperative laboratory values, operative urgency, and time. RESULTS Of the 11 462 patients included, 3.1% (n = 350) underwent an unplanned cranial reoperation. The most common reasons for cranial reoperation were intracranial hematoma evacuation (22.5%), superficial or intracranial surgical site infections (11.9%), re-resection of tumor (8.4%), decompressive craniectomy (6.1%), and repair of cerebrospinal fluid leakage (5.6%). The strongest predictor of any cranial reoperation was preoperative thrombocytopenia (less than 100 000/μL, odds ratio [OR] = 2.51, 95% confidence interval [CI]: 1.23-5.10, P = .01). Thrombocytopenia, hypertension, emergent surgery, and longer operative time were predictors of reoperation for hematoma (P ≤ .004), while dependent functional status, morbid obesity, leukocytosis, and longer operative time were predictors of reoperation for infection (P < .05). Although any unplanned cranial reoperation was not associated with differential odds of mortality (OR = 1.68, 95% CI: 0.94-3.00, P = .08), hematoma evacuation was significantly associated with thirty-day death (P = .04). CONCLUSION In this national analysis, unplanned cranial reoperation was primarily associated with operative indices, rather than preoperative characteristics, suggesting that reoperation may have some utility as a quality indicator. However, hypertension and thrombocytopenia were potentially modifiable predictors of reoperation.

• Publisher: Oxford University Press,Copyright by the Congress of Neurological Surgeons,Wolters Kluwer Health, Inc
• Subject: Adult / Aged / Brain Neoplasms - mortality / Brain Neoplasms - surgery / Craniotomy - adverse effects / Craniotomy - methods / Craniotomy - mortality / Female / Humans / Hypertension / Logistic Models / Longitudinal Studies / Male / Middle Aged / Postoperative Complications - epidemiology / Prospective Studies / Quality control / Quality Improvement / Registries / Reoperation - mortality / Reoperation - statistics & numerical data