The Influence of Preoperative Dependency on Mortality, Functional Recovery, and Complications after Microsurgical Resection of Intracranial Tumors

Aim: The decision whether to operate on patients with intracranial tumors is complex and influenced by patient-specific factors, including the preoperative functional status. It was our objective to assess risks for mortality and complications, and postoperative recovery in functionally dependent patients undergoing microsurgical resection of intracranial tumors.

Methods: Observational two-center study, analyzing institutional registry data. Dependency was defined as admission Karnofsky Performance Scale (KPS) of ≤ 50. The primary end point was in-hospital mortality. Secondary end points were rate and type (Clavien-Dindo grade [CDG]) of complications, as well as postoperative change in KPS until the 3-month follow-up (M3).

Results: Of n = 1951 patients, n = 98 (5.0%) were dependent. Mortality rates were 2.0% for dependent and 0.4% for independent patients (p = 0.018). In univariate analysis, dependent patients were more likely than independent patients to die in hospital (odds ratio [OR] 5.49, 95% confidence interval [CI] 1.12–26.8, p = 0.035). In a multivariate model, the effect was slightly attenuated (OR 4.75, 95% CI 0.91–24.7, p = 0.064). Dependent patients tended to experience more postoperative complications. They were more likely to suffer from a severe complication (CDG 4&5; OR 3.55, 95% CI 1.49–8.46, p = 0.004). In 40.8% and 52.4% of cases, dependent patients regained functional independence at discharge and M3, respectively.

Conclusions: In operated patients with intracranial tumors presenting functionally dependent at admission, the risk for in-hospital mortality and complications is elevated. However, if conducted successfully, surgery may lead to regain of independence in every second patient within 3 months.