The influence of preoperative dependency on mortality, functional recovery and complications after microsurgical resection of intracranial tumors

J Neurooncol. 2018 Sep;139(2):441-448. doi: 10.1007/s11060-018-2882-9. Epub 2018 May 2.


Introduction: The decision whether to operate on patients with intracranial tumors is complex and influenced by patient-specific factors, including the preoperative functional status. This work assesses the risks for mortality and complications, and post-operative 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 endpoint was in-hospital mortality. Secondary endpoints 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 univariable analysis, dependent patients were more likely than independent patients to die in hospital (OR 5.49, 95% CI 1.12-26.8, p = 0.035). In a multivariable 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 and 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.

Keywords: Brain tumor; Care; Complications; Functional dependence; Mortality; Neuro-oncology; Outcome.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / mortality*
  • Brain Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Karnofsky Performance Status
  • Male
  • Microsurgery*
  • Middle Aged
  • Neurosurgical Procedures*
  • Postoperative Complications* / diagnosis
  • Prognosis
  • Prospective Studies
  • Recovery of Function*
  • Registries
  • Retrospective Studies
  • Tumor Burden