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Anesthesiology. 2018 Dec;129(6):1111-1120. doi: 10.1097/ALN.0000000000002426.

Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy: A Multicenter Observational Study.

Author information

1
From the Anesthesia and Critical Care Department, Hôtel Dieu, University Hospital of Nantes, Nantes, France (R.C., A.G., K.A.) Anesthesia and Critical Care Department, Hôpital La Timone, University Hospital of Marseille, Marseille, France (N.B., T.T.) Anesthesia and Critical Care Department, Hôpital Pierre-Paul Ricquet, University Toulouse 3-Paul Sabatier, Toulouse, France (M.S., T.G., V.A.) Anesthesia and Critical Care Department, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France (C.P.-B., J.J.) Anesthesia and Critical Care Department, Hôpital Pontchaillou, University Hospital of Rennes, and University of Rennes 1, Rennes, France (H.B., S.V., M.G.) Anesthesia and Critical Care Department, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France (J.P., D.V.) Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital of Nantes, Saint-Herblain, France (K.L., Y.B., B.R.) Institut du Thorax, Institut National de la Santé et de la Recherche Médicale, UMR1087, Institut de Recherche en Santé, University Hospital of Nantes, Nantes, France (B.R.) Plateforme de Méthodologie et de Biostatistique, Cellule de Promotion de la Recherche Clinique, University Hospital of Nantes, Nantes, France (A.L.T., F.F.) Institut National de la Santé et de la Recherche Médicale MethodS for Patients-centered outcomes and HEalth REsearch U1246, Unité de Formation de Recherche des Sciences Pharmaceutiques, University of Nantes, University of Tours, Nantes, France (F.F.) Laboratoire Unité propre de l'enseignement supérieur et de recherche EA 3826, University Hospital of Nantes, Nantes, France (K.A.). Anesthesia and Critical Care Department, Hôpital Cochin, Paris, France Anesthesia and Critical Care Department, Hôpital Foch, Suresnes, France Anesthesia and Critical Care Department, Hôpital Raymond Poincaré, Garches, France Anesthesia and Critical Care Department, Hôpital Européen Georges Pompidou, Paris, France. Anesthesia and Critical Care Department, Hôpital Européen Georges Pompidou, Paris, France.

Abstract

WHAT WE ALREADY KNOW ABOUT THIS TOPIC:

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting.

METHODS:

Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in-intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression.

RESULTS:

Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In-intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively.

CONCLUSIONS:

The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score's performance before routine use.

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