Rahmani Redi, Tomlinson Samuel B, Santangelo Gabrielle, Warren Kwanza T, Schmidt Tyler, Walter Kevin A, Vates G Edward
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States of America.
School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, United States of America.
J Geriatr Oncol. 2020 May;11(4):694-700. doi: 10.1016/j.jgo.2019.10.019. Epub 2019 Nov 6.
Craniotomy for tumor resection improves survival in adults aged ≥65 years with malignant glioma. However, the decision to attempt resection must be weighed against the near-term risks of surgery. This study examined risk factors associated with unfavorable 30-day outcomes following craniotomy for malignant glioma resection in older adult patients.
The American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016 was queried for patients aged 65-89 years undergoing craniotomy for primary, supratentorial, malignant, intra-axial tumor resection. 30-day outcomes included mortality, life-threatening complication, unplanned readmission, reoperation, and change in living disposition. Independent risk factors were identified through multiple logistic regression.
In total, 1016 cases met eligibility criteria. Death occurred in 35 cases (3.4%). 58 patients (5.7%) suffered at least one life-threatening complication. Risk factors for morbidity and mortality included frontal lobe tumor, corticosteroid use, dependent functional status, and underweight body mass index (BMI). Among 816 patients admitted from home, 33.9% experienced a change in living disposition, which was associated with advanced age, female sex, frontal lobe tumor, underweight BMI, and diabetes mellitus (among others). Readmission (11.8%) was most frequently attributed to altered mental status, seizure, or venous thromboembolism. Reoperation was rare (4.5%).
Death and life-threatening morbidity were rare early outcomes for older adult patients undergoing malignant glioma resection. However, one in three patients admitted from home experienced a change in living disposition. Factors related to baseline state of health, tumor location, and corticosteroid regimen should be considered when anticipating the immediate postoperative course.
对于年龄≥65岁的恶性胶质瘤成年患者，开颅肿瘤切除术可提高生存率。然而，决定尝试切除手术时必须权衡手术的近期风险。本研究探讨了老年成年患者行恶性胶质瘤切除术后30天不良结局的相关危险因素。
查询美国外科医师学会国家外科质量改进计划数据库中2012年至2016年期间年龄在65 - 89岁、因原发性幕上轴内恶性肿瘤行开颅切除术的患者。30天结局包括死亡率、危及生命的并发症、计划外再入院、再次手术以及生活状态改变。通过多因素逻辑回归确定独立危险因素。
共有1016例病例符合纳入标准。35例（3.4%）死亡。58例患者（5.7%）至少发生1次危及生命的并发症。发病和死亡的危险因素包括额叶肿瘤、使用皮质类固醇、依赖性功能状态以及体重指数（BMI）偏低。在816例从家中入院的患者中，33.9%的患者生活状态发生改变，这与高龄、女性、额叶肿瘤、BMI偏低以及糖尿病等因素有关。再入院（11.8%）最常见的原因是精神状态改变、癫痫发作或静脉血栓栓塞。再次手术很少见（4.5%）。
对于接受恶性胶质瘤切除术的老年成年患者，早期死亡和危及生命的发病情况很少见。然而，三分之一从家中入院的患者生活状态发生了改变。在预测术后即刻病程时，应考虑与健康基线状态、肿瘤位置和皮质类固醇治疗方案相关的因素。
