Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature

• Authors: Ramin A Morshed, University of California, San Francisco; Jacob S Young, University of California, San Francisco; Andrew J Gogos, University of California, San Francisco; Alexander F Haddad, University of California, San Francisco; James T McMahon, Emory University; Annette M Molinaro, University of California, San Francisco; Vivek Sudhakar, University of Pittsburgh; Nadeem Al-Adli, TCU and UNTHSC; Shawn L Hervey-Jumper, University of California, San Francisco; Mitchel S Berger, University of California, San Francisco
• Journal Title: ACTA NEUROCHIRURGICA
• Volume: Volume 164, Number 2
• Publisher: Springer (part of Springer Nature) | 2022-01-01, Pages 405-417
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1007/s00701-021-05067-9
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Complications; Glioma; Recurrence; Surgical resection

Abstract

Background There is a concern that glioma patients undergoing repeat craniotomies are more prone to complications. The study’s goal was to assess if the complication profiles for initial and repeat craniotomies were similar, to determine predictors of complications, and to compare results with those in the literature. Methods A retrospective study was conducted of glioma patients (WHO grade II–IV) who underwent either an initial or repeat craniotomy performed by the senior author from 2012 until 2019. Complications were recorded by discharge, 30 days, and 90 days postoperatively. New neurologic deficits were recorded by 90 days postoperatively. Multivariate regression was performed to identify factors associated with complications. A meta-analysis was performed to identify rates of complications based on number of prior craniotomies. Results Within the cohort of 714 patients, 400 (56%) had no prior craniotomies, 218 (30.5%) had undergone 1 prior craniotomy, and 96 (13.5%) had undergone ≥ 2 prior craniotomies. There were 27 surgical and 10 medical complications in 30 patients (4.2%) and 19 reoperations for complications in 19 patients (2.7%) with no deaths by 90 days. Complications, reoperation rates, and new neurologic deficits did not differ based on number of prior craniotomies. On multivariate analysis, older age (OR1.5, 95%CI 1.0–2.2) and significant leukocytosis due to steroid use (OR12.6, 95%CI 2.5–62.9) were predictors of complications. Complication rates in the cohort were lower than rates reported in the literature. Conclusion Contrary to prior reports in the literature, repeat craniotomies can be as safe as initial operations if surgeons implement best practices.