Department of Rehabilitation Medicine, Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York, USA.
Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA.
PM R. 2022 Jan;14(1):40-45. doi: 10.1002/pmrj.12573. Epub 2021 Apr 13.
Inpatient rehabilitation improves function in people with brain tumors, including glioblastoma multiforme (GBM) but there are limited data on the impact of multiple resections on outcomes. We hypothesize that outcomes will be more favorable for those patients with a single resection when compared to those with more than one resection.
To examine functional outcomes in inpatient rehabilitation for people with GBM who underwent one or more resections prior to admission.
Retrospective analysis.
Inpatient rehabilitation unit within a large, urban, academic medical center.
Patients who were admitted to our institution for the treatment of initial GBM or GBM recurrence necessitating surgical resection or repeat resection.
Not applicable.
MAIN OUTCOME MEASURE(S): Total FIM Change, Total Functional Independence Measure (FIM) Efficiency, Motor and Cognitive FIM efficiency, and proportion discharged home.
From 2006 to 2016, 94 persons with GBM were admitted. Eight were readmissions classified as "repeat" and another seven transferred to the medical floor and excluded. Of the 79 patients included, 56 were first and 23 second resections, with a group mean age of 62.7 + 12.2 years and were 51% male. On analysis of covariance, change in FIM score from admission to discharge was insignificant between groups, adjusted for age and acute care length of stay (17.1 vs. 17.4, F[1, 75] = 0.027, P = .871). Likewise, the proportion of home discharge was not significant between groups (chi-square, 75.0% vs. 78.3%, P = .758).
Patients who have undergone second resections for GBM are reasonable candidates for admission to the inpatient rehabilitation units despite carrying a poor prognosis and having multiple exposures to surgical morbidity. Factors to take into account are that candidates considered for a second resection may be relatively younger or healthier and therefore may perform better from a functional standpoint. In addition, postoperative steroid administration may play a role in the similarities the authors noted. A larger, multicenter study should validate our findings (limited by sample size and a single location) and identify factors predicting a successful outcome.
住院康复可以改善脑肿瘤患者的功能，包括多形性胶质母细胞瘤（GBM），但关于多次切除对结果的影响的数据有限。我们假设，与多次切除相比，单次切除的患者预后更好。
检查接受过一次或多次切除的 GBM 患者在住院康复期间的功能结果。
回顾性分析。
大型城市学术医疗中心的住院康复病房。
入院治疗初始 GBM 或 GBM 复发的患者，需要手术切除或重复切除。
不适用。
总 FIM 变化、总功能独立性测量（FIM）效率、运动和认知 FIM 效率以及出院回家的比例。
2006 年至 2016 年，94 名 GBM 患者入院。8 名再入院患者被归类为“重复”，另外 7 名转入内科病房并被排除。在纳入的 79 名患者中，56 名患者为首次切除，23 名患者为第二次切除，平均年龄 62.7±12.2 岁，51%为男性。协方差分析显示，从入院到出院 FIM 评分的变化在组间无显著差异，调整年龄和急性护理住院时间后（17.1 比 17.4，F[1,75] = 0.027，P = 0.871）。同样，出院回家的比例在组间也无显著差异（卡方，75.0%比 78.3%，P = 0.758）。
尽管 GBM 患者预后较差，多次暴露于手术发病率中，但他们仍然是接受住院康复治疗的合理候选者。需要考虑的因素是，考虑进行第二次切除的候选者可能相对年轻或更健康，因此从功能角度来看可能表现更好。此外，术后类固醇的应用可能是作者注意到的相似点的原因之一。一项更大的、多中心研究应该验证我们的发现（受样本量和单一地点的限制），并确定预测成功结果的因素。
