When Are Complications After Brain Tumor Surgery Detected?

Abstract

Objective: To optimize follow-up and surveillance routines after intracranial surgery, knowledge about when complications occur is needed. We sought to explore when postoperative complications are detected after brain tumor surgery and assess their severity.

Methods: We performed a retrospective review of hospital records in 1291 adult patients undergoing elective craniotomy for intracranial tumors between 2008 and 2016 at our institution. Medical history, comorbidity, registered outcomes within 30 days, and time of detection of complications were registered. The severity and nature of complications were graded via the Landriel classification system.

Results: A total of 708 complications were registered in 465 (36.0%) operations within the first 30 days; 30.6% experienced mild or moderate complications (grade I-II), and 5.4% experienced severe or fatal complications (grade III-IV). A total of 5.7% (n = 74) developed complications within 24 hours; 45.7% of severe and fatal complications and 8.6% of mild and moderate complications were detected within 24 hours, whereas 77.1% and 57.5%, respectively, were detected within 1 week. Multivariate analysis revealed that Karnofsky Performance Status score <70 and longer duration of surgery were factors associated with developing severe or fatal complications.

Conclusions: Mild and moderate complications, dominated by extracranial infections such as urinary tract infections and pneumonias, are very common after intracranial tumor surgery. Detection rates for mild and moderate complications are probably greatly affected by local routines for surveillance, screening, discharge, documentation, and follow-up, perhaps limiting their usefulness as a quality measure. Severe and fatal complications are mainly detected in the early postoperative course.

Keywords: Brain tumor; ICU; Neurosurgery; Postoperative complications.