Gao Zhichao, Zhang Yuhang, Guan Jiaqing, Dong Weifeng, Huang Cheng
Department of Neurosurgery, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China.
Department of Orthopedics, The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China.
PLoS One. 2025 Jun 2;20(6):e0324928. doi: 10.1371/journal.pone.0324928. eCollection 2025.
Prior studies have established preoperative wait time as a potential risk factor for postoperative outcomes across various clinical conditions. However, associations between wait time and short-term prognosis following intracranial tumor surgery are still largely unknown. Our study sought to investigate associations between preoperative wait time and postoperative thirty-day mortality following intracranial tumor craniotomy in adult patients.
This retrospective cohort study utilized data extracted from the ACS NSQIP database, comprising 18,298 adult patients who underwent intracranial tumor craniotomy between 2012 and 2015. The primary exposure and outcome were preoperative wait time and postoperative thirty-day mortality, respectively. Smooth curve fitting evaluated the linear or nonlinear association between them. The effects of exposure on outcome were evaluated using multivariate Cox proportional hazard regression models and Kaplan-Meier curves. Subgroup analyses and interaction testing were conducted to evaluate the effect modification of confounding factors. The robustness of the main results was assessed through propensity score matching and sensitivity analyses.
Prolonged preoperative wait time was independently and linearly related to elevated thirty-day mortality (HR = 1.075, 95%CI: 1.040-1.110). The ventilator-dependent status significantly modify the relationship between wait time and mortality. The linear wait time-mortality association was observed solely in non-ventilator-dependent patients, showing an 8.3% increase in thirty-day mortality risk for each additional day of waiting (HR = 1.083, 95%CI: 1.049-1.119). Patients who waited ≥1 day had a 0.74% higher absolute risk and a 31.3% higher relative risk of thirty-day mortality compared to those who waited <1 day. The sensitivity analyses corroborated the robustness of these results.
Prolonged preoperative wait time has an independent linear association with elevated postoperative thirty-day mortality in non-ventilator-dependent adult patients undergoing intracranial tumor craniotomy. Clinicians should minimize preoperative wait time to mitigate the risk of thirty-day mortality. Nonetheless, further research is warranted to validate the results and establish causality.
先前的研究已将术前等待时间确定为各种临床情况下术后结局的潜在风险因素。然而，等待时间与颅内肿瘤手术后短期预后之间的关联仍 largely 未知。我们的研究旨在调查成年患者颅内肿瘤开颅术后术前等待时间与术后 30 天死亡率之间的关联。
这项回顾性队列研究利用了从 ACS NSQIP 数据库中提取的数据，该数据库包含 2012 年至 2015 年间接受颅内肿瘤开颅手术的 18298 名成年患者。主要暴露因素和结局分别为术前等待时间和术后 30 天死亡率。平滑曲线拟合评估了它们之间的线性或非线性关联。使用多变量 Cox 比例风险回归模型和 Kaplan-Meier 曲线评估暴露对结局的影响。进行亚组分析和交互作用检验以评估混杂因素的效应修正。通过倾向得分匹配和敏感性分析评估主要结果的稳健性。
术前等待时间延长与 30 天死亡率升高独立且呈线性相关（HR = 1.075，95%CI：1.040 - 1.110）。依赖呼吸机的状态显著改变了等待时间与死亡率之间的关系。仅在不依赖呼吸机的患者中观察到线性等待时间 - 死亡率关联，等待时间每增加一天，30 天死亡风险增加 8.3%（HR = 1.083，95%CI：1.049 - 1.119）。等待≥1 天的患者与等待<1 天的患者相比，30 天死亡的绝对风险高 0.74%，相对风险高 31.3%。敏感性分析证实了这些结果的稳健性。
在接受颅内肿瘤开颅手术的不依赖呼吸机的成年患者中，术前等待时间延长与术后 30 天死亡率升高存在独立的线性关联。临床医生应尽量缩短术前等待时间以降低 30 天死亡风险。尽管如此，仍需进一步研究以验证结果并确定因果关系。
