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

Neurosurgery. 2017 Nov 1;81(5):761-771. doi: 10.1093/neuros/nyx089.

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.

Keywords: Brain tumor; Craniotomy; Intracranial hematoma; NSQIP; Reoperation; Surgical site infections; Thrombocytopenia.

MeSH terms

  • Adult
  • Aged
  • Brain Neoplasms / mortality
  • Brain Neoplasms / surgery*
  • Craniotomy / adverse effects*
  • Craniotomy / methods
  • Craniotomy / mortality
  • Female
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Prospective Studies
  • Quality Improvement
  • Registries
  • Reoperation / mortality
  • Reoperation / statistics & numerical data*