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Risk factors for developing untreated preoperative hydrocephalus using univariate and multivariate regression analysis*
Source publication
Object:
The aim of this study was to investigate the incidence of CSF disturbances before and after intracranial surgery for pediatric brain tumors in a large, contemporary, single-institution consecutive series.
Methods:
All pediatric patients (those < 18 years old), from a well-defined population of 3.0 million inhabitants, who underwent crani...
Contexts in source publication
Context 1
... < 0.001), and in cerebellum (OR 11.1, 95% CI 5.2-25.0; p < 0.001); and histology (p < 0.001; Table 3, Fig. 2). ...
Context 2
... < 0.001), main tumor location infraten- torial (OR 3.3, 95% CI 1.9-5.8; p < 0.001), and histology (p < 0.01; Table 3). ...
Context 3
... ous series have reported rates of hydrocephalus prior to surgery ranging from 69% up to 92%, although most of these studies concerned tumors in the posterior fossa re- gion. 2,4,9,19,25,34 We found that younger patient age and infratento- rial tumor location were the two most important risk fac- tors for preoperative hydrocephalus (Table 3), which is in accordance with results from previous studies. 34 With respect to patient age, this might partially be explained by an immaturity of the arachnoid granulations (pacchio- nian bodies) for CSF reabsorption in the young, as they only reach functionality in the late infantile period. ...
Context 4
... With respect to patient age, this might partially be explained by an immaturity of the arachnoid granulations (pacchio- nian bodies) for CSF reabsorption in the young, as they only reach functionality in the late infantile period. 37 With respect to tumor histology, PNETs were signifi- cantly associated with a higher risk of preoperative hy- drocephalus compared with WHO Grade I tumors (Table 3). This is in accordance with the published literature, al- though the main focus of these studies has been restricted to tumors located in the posterior fossa and less attention has been given to the precise significance of tumor histo- pathology. ...
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Introduction Brain tumors are of the most devastating forms of human disorders, particularly when they arise in the posterior fossa. The proximity of these lesions to the brainstem and fourth ventricle explains the common presentation of these patients. Obstructive hydrocephalus is described in about 80% of the cases, it can lead to herniation and...
Citations
... Of the 323 studies screened, 21 proved viable to be included in the meta-analysis. Of those included, 9 studies reported data regarding bone cement [1,12,14,15,18,25,27,28,36] and 13 regarding bone flap utilization; [8][9][10][11]13,[22][23][24]27,29,30,32,33] two studies had data for both groups [ Table 1]. A total of 3424 cases were statistically analyzed, 1351 cases using bone cement, and 2073 using bone flap. ...
Background
Posterior fossa surgeries are often performed to treat infratentorial pathologies, such as tumors that increase intracranial pressure. Posterior fossa craniotomy has been shown to decrease the incidence of postoperative complications and morbidity compared to craniectomy. More recently, the use of bone cement in posterior fossa craniotomies has been implemented, but there is limited comparative postoperative data of this technique to more commonly used bone flap replacement. This study aims to address this information gap through a meta-analysis comparing the incidence of postoperative cerebrospinal fluid leakage and other complications when utilizing bone cement versus bone flap replacement in posterior fossa craniotomies.
Methods
Following a literature review, search parameters for a systematic review were identified and relevant studies were sorted based on selection criteria to be included in the meta-analysis. Data analysis was performed in R studio and Microsoft Excel software. Targeted complications for analysis include cerebrospinal fluid (CSF) leakage, pseudomeningocele formation, and infection. Pooled estimates and odds ratios for dichotomous outcomes were calculated with corresponding 95% confidence intervals, and findings were translated into illustrative tables and figures.
Results
Twenty-one articles were included in a systematic review, nine studies using bone cement and thirteen using bone flap (two studies reported data for both groups). With bone flap replacement, CSF leakage was 8.36% (95% confidence interval [CI] 5.89–10.86%), pseudomeningocele formation was 9.22% (95% CI 4.82–13.62%), and infection was 6.85% (95% CI 4.05–9.65%). With bone cement usage, CSF leakage was 3.47% (95% CI 2.37–4.57%), pseudomeningocele formation was 2.43% (95% CI 1.23–3.63%), and infection was 1.85% (95% CI 0.75–2.95%). The odds ratio of CSF leak, pseudomeningocele formation, and infection was 0.39 (95% CI 0.229–0.559), 0.25 (95% CI 0.137–0.353), and 0.26 (95% CI 0.149–0.363), respectively, with the use of bone cement compared to craniotomy.
Conclusion
Outcomes demonstrated in this meta-analysis revealed an overall decreased incidence of postoperative complications rates of CSF leak, pseudomeningocele formation, and infection when using bone cement compared to bone flap in posterior fossa craniotomies. Our study suggests that bone cement use is safe and effective in posterior fossa surgery. Future studies should further assess the comparative outcomes of these techniques.
... 3 Thereby extensive research into risk factors of CSF leakage after intradural cranial surgery in the pediatric population is lacking, and the majority of studies only report on specific subcategories, for example, posterior fossa tumor surgery. [4][5][6][7] The term "CSF leakage" may be used imprecisely to mean both incisional leakage and pseudomeningocele (PMC). Incisional CSF leakage is defined as leakage of CSF through the skin, whereas PMC is a subcutaneous collection of CSF. ...
... This result is in accordance with findings in previous publications. [3][4][5][6][7] The CSF leakage rate in our subgroup of craniectomy procedures is comparable to that found by Gnanalingham et al. (27%). 6 The increased CSF leakage risk may be explained by the lack of rigid support, otherwise provided by the replaced bone flap, which allows the dura to bulge outward, combined with pulsatile CSF dynamics. ...
... Infratentorial surgery has been reported as a risk factor for CSF leakage in previous studies, yet was not significantly associated in our multivariate analysis. [3][4][5]12 This suggests that factors relating to CSF pressure dynamics are most important in predicting CSF leakage, and thus adequate control of CSF flow should be sought in order to prevent it. 5,6 Younger age and male sex have also been reported by some studies as risk factors for CSF leakage, which was not replicated by the current study. ...
OBJECTIVE
The risk of cerebrospinal fluid (CSF) leakage after cranial surgery and its associated complications in children are unclear because of variable definitions and the lack of multicenter studies. In this study, the authors aimed to establish the incidence of CSF leakage after intradural cranial surgery in the pediatric population. In addition, they evaluated potential risk factors and complications related to CSF leakage in the pediatric population.
METHODS
The authors performed an international multicenter retrospective cohort study in three tertiary neurosurgical referral centers. Included were all patients aged 18 years or younger who had undergone cranial surgery to reach the subdural space during the period between 2015 and 2021. Patients who died or were lost to follow-up within 6 weeks after surgery were excluded. The primary outcome measure was the incidence of CSF leakage, defined as leakage through the skin, within 6 weeks after surgery. Univariable and multivariable logistic regression analyses were performed to identify risk factors for and complications related to CSF leakage.
RESULTS
In total, 759 procedures were identified, performed in 687 individual patients. The incidence of CSF leakage was 7.5% (95% CI 5.7%–9.6%). In the multivariate model, independent risk factors for CSF leakage were hydrocephalus (OR 4.5, 95% CI 2.2–8.9) and craniectomy (OR 7.6, 95% CI 3.0–19.5). Patients with CSF leakage had higher odds of pseudomeningocele (5.7, 95% CI 3.0–10.8), meningitis (21.1, 95% CI 9.5–46.8), and surgical site infection (7.4, 95% CI 2.6–20.8) than patients without leakage.
CONCLUSIONS
CSF leakage risk in children after cranial surgery, which is comparable to the risk reported in adults, is an event of major concern and has a serious clinical impact.
... They linked this complication with some variables like age less than 3 years, female sex, infratentorial surgeries, and untreated preoperative hydrocephalus. In another analysis by the same group including 381 craniotomies for tumor, they reported that younger age, infratentorial location, and new-onset postoperative hydrocephalus as being significantly associated with postoperative CSF leaks [23]. Norrdahl et al., stated eighteen children with pseudomeningocele in their study developed CSF leak.These patients often underwent reoperations for one or more indications in addition to long durations of intravenous antibiotics, all resulting in extended hospital stay and increased cost [14]. ...
... Numerous research studies have suggested that pediatric patients with subtentorial ventricle tumors can more easily develop postresection hydrocephalus than adult patients due to the characteristic of unique tumor pathology in each ages (24,25). By contrast, for patients with LVTs, although a rather part of pediatric patients has primary symptomatic hydrocephalus, the common types of tumor in pediatric patients are benign, and most pediatric patients will not develop acute or persistent hydrocephalus after resection (26). Perilesional edema was the only independent risk factor for VP shunt placement after surgery in our series after two cases of isolated hydrocephalus were excluded in the regression analysis. ...
Objective
There is no general consensus on the placement of preoperative and intraoperative external ventricular drainage (EVD) in patients with lateral ventricular tumors (LVTs). The aim of this study was to identify the predictors of postoperative acute and persistent hydrocephalus need for postoperative cerebrospinal fluid (CSF) drainage and guide the management of postoperative EVD in patients with LVTs.Methods
We performed a single-institution, retrospective analysis of patients who underwent resection of LVTs in our Department between January 2011 and March 2021. Patients were divided between one group that required CSF drainage and another group without the need for CSF drainage. We analyzed the two groups by univariate and multivariate analyses to identify the predictors of the requirement for postoperative CSF drainage due to symptomatic intracranial hypertension caused by hydrocephalus.ResultsA total of 97 patients met the inclusion criteria, of which 31 patients received preoperative or intraoperative EVD. Ten patients without prophylactic EVD received postoperative EVD for postoperative acute hydrocephalus. Eleven patients received postoperative ventriculoperitoneal(VP) shunt subsequently. Logistic regression analysis showed that tumor invasion of the anterior ventricle (OR = 7.66), transependymal edema (OR = 8.76), and a large volume of postoperative intraventricular hemorrhage (IVH) (OR = 6.51) were independent risk factors for postoperative acute hydrocephalus. Perilesional edema (OR = 33.95) was an independent risk factor for postoperative VP shunt due to persistent hydrocephalus.Conclusion
Postoperative hydrocephalus is a common complication in patients with LVTs. These findings might help to determine whether to conduct earlier interventions.
... Craniotomies for removal of brain tumors form the core treatment of these potentially deadly diseases and have been proven to prolong life [31,39] and improve quality of life and overall survival [20,33]. Nonetheless, infections [24,26,27], bleeding [13,27], surgical morbidity/mortality including neurological sequelae [2,27], and CSF disturbances [16][17][18]26] are potential risks of surgery. ...
... Hydrocephalus has been extensively studied with abundant evidence for its treatment with procedures such as external ventricular drainage (EVD), endoscopic third ventriculostomy (ETV), and ventriculoperitoneal (VP) shunts [14,16,21,30]. Although the main objective of treating hydrocephalus with VP shunts is to establish a permanent CSF diversion, achieving maximum VP shunt survival, defined as time from implantation to its malfunction, still remains challenging. ...
... Although the main objective of treating hydrocephalus with VP shunts is to establish a permanent CSF diversion, achieving maximum VP shunt survival, defined as time from implantation to its malfunction, still remains challenging. Numerous studies have been published on postoperative shunting and shunt-survival rates with respect to the pediatric population [16], hemorrhage-related hydrocephalus [28,34], infections [4,8,24,25], shunting related to specific tumor types [3,19], and vascular brain malformations [15]. However, studies on shunt-survival rates and risks leading to shunt failure with respect to brain tumors remain scarce. ...
Risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus after craniotomies for brain tumors are largely unknown. The purpose of this study was to determine the overall timing of VP shunting and its failure after craniotomy for brain tumors in adults. The authors also wished to explore risk factors for early VP shunt failure (within 90 days). A population-based consecutive patient cohort of all craniotomies for intracranial tumors leading to VP shunt dependency in adults (> 18 years) from 2004 to 2013 was studied. Patients with pre-existing VP shunts prior to craniotomy were excluded. The survival time of VP shunts, i.e., the shunt longevity, was calculated from the day of shunt insertion post-craniotomy for a brain tumor until the day of shunt revision requiring replacement or removal of the shunt system. Out of 4774 craniotomies, 85 patients became VP shunt-dependent (1.8% of craniotomies). Median time from craniotomy to VP shunting was 1.9 months. Patients with hydrocephalus prior to tumor resection (N = 39) had significantly shorter time to shunt insertion than those without (N = 46) (p < 0.001), but there was no significant difference with respect to early shunt failure. Median time from shunt insertion to shunt failure was 20 days (range 1–35). At 90 days, 17 patients (20%) had confirmed shunt failure. Patient age, sex, tumor location, primary/secondary craniotomy, extra-axial/intra-axial tumor, ventricular entry, post-craniotomy bleeding, and infection did not show statistical significance. The risk of early shunt failure (within 90 days) of shunts after craniotomies for brain tumors was 20%. This study can serve as benchmark for future studies.
... Presence of hydrocephalus preoperatively should be considered as determining factor for management, approach of surgery to the lesion, and determining the priority either to deal with hydrocephalus or the lesion at first [1,2]. Persistence or occurrence of hydrocephalus after surgery, even with total removal of the lesions, raises the question about the pathogenesis of hydrocephalus, as according to the classic CSF circulatory theory of hydrocephalus that stands that removal of the obstructing element of CSF pathway should eliminate the incidence of hydrocephalus, which does not always occur, as there is high incidence of hydrocephalus with these lesions [3]. Another issue is how the hydrocephalus appears postoperatively and how to deal with it after surgery as there are many factors that should be considered as persistence of blood in CSF, possibility of infection and ventriculitis, presence of previous craniotomy, puncture of the lateral ventricle, and presence of gliosis within the ventricular system which may lead to compartmentalization [3]. ...
... Persistence or occurrence of hydrocephalus after surgery, even with total removal of the lesions, raises the question about the pathogenesis of hydrocephalus, as according to the classic CSF circulatory theory of hydrocephalus that stands that removal of the obstructing element of CSF pathway should eliminate the incidence of hydrocephalus, which does not always occur, as there is high incidence of hydrocephalus with these lesions [3]. Another issue is how the hydrocephalus appears postoperatively and how to deal with it after surgery as there are many factors that should be considered as persistence of blood in CSF, possibility of infection and ventriculitis, presence of previous craniotomy, puncture of the lateral ventricle, and presence of gliosis within the ventricular system which may lead to compartmentalization [3]. ...
... The management of hydrocephalus in patients with surgically resectable lateral ventricular lesions remains a great challenge and controversial. Gross total lesion excision, even with low-grade pathologies, is not a safeguard against developing hydrocephalus [3]. So, hydrocephalus pathogenesis with lateral ventricular lesions is not only due to obstruction of CSF pathway, with taking into consideration the classic CSF circulatory theory, but it was also assumed that communicating hydrocephalus in these cases occurs due to many factors as high protein content and blood in CSF affect arachnoid granulations, inflammatory process in subarachnoid space takes place due to subarachnoid blood and proteins and affection of dural sinuses during craniotomies [3]. ...
Background
Lateral ventricular lesions associated with hydrocephalus are considered a challenge to neurosurgeons. Hydrocephalus after surgery of such lesions and its pathogenesis and how to deal with it is a big question facing neurosurgeons.
Objectives
In this study, we tried to discuss the pathogenesis and different forms of presentation of hydrocephalus in lateral ventricular lesions and how to deal with it.
Methods
Eleven patients with lateral ventricular lesions associated with hydrocephalus either preoperative or postoperative presenting to our hospital were managed by excision of the lesion. A prospective study was done for these cases including their clinical data, radiological data, the presence, or absence of hydrocephalus either preoperative or postoperative and how we managed it.
Results
This study included 11 cases. The mean patient age at surgery was 25 years old. Nine cases were presented with radiological signs of hydrocephalus preoperatively. Two cases developed new onset hydrocephalus after lesion excision. Six cases ended with permanent CSF diversion.
Conclusion
Management of cases with lateral ventricular lesions does not stand on only excision of the lesion. Hydrocephalus should be kept into consideration perioperatively. We should try to avoid events that could lead to ventriculitis. Prolonged follow-up of the patients postoperative is very important as hydrocephalus may develop later after surgery.
... In the pediatric population, specifically, the burden of additional treatment that may be required for CSF leakage or related complications is substantial. In studies reporting data on treatment of CSF leakage, a total of 37 out of 114 patients with a CSF leak were treated with a ventriculoperitoneal shunt [2,5,7,9,14,19,20,23,34,35]. ...
... The majority of studies included in this metaanalysis do not clearly define the outcome measure CSF leakage. Those that do, use a variety of definitions, for example, being "CSF leak through the skin" [35] and "all CSF leaks requiring surgical intervention" [14]. This obviously results in differences in outcome, as is reflected by the I 2 -values found in the meta-analyses. ...
... Overview of included studiesExcluded from meta-analysis because of overlap withSteinbok et al. 2007 Excluded from meta-analysis because of overlap withGnanalingham et al. 2002 Excluded from meta-analysis because of overlap withHosainey et al. 2014 Excluded from meta-analysis because of overestimation of CSF leakage resulting from wound drainage and inclusion of clear production in the drainage system as CSF leakage e Excluded from meta-analysis because of overlap withRoth et al. 2018 including the study of Jiang et al. The overall CSF leakage rate in studies of good quality[14,26,35] is 7.4% (95% CI 4.6 to 11.6%). ...
Background
Cerebrospinal fluid (CSF) leakage is a common complication after neurosurgical intervention. It is associated with substantial morbidity and increased healthcare costs. The current systematic review and meta-analysis aim to quantify the incidence of cerebrospinal fluid leakage in the pediatric population and identify its risk factors.
Methods
The authors followed the PRISMA guidelines. The Embase, PubMed, and Cochrane database were searched for studies reporting CSF leakage after intradural cranial surgery in patients up to 18 years old. Meta-analysis of incidences was performed using a generalized linear mixed model.
Results
Twenty-six articles were included in this systematic review. Data were retrieved of 2929 patients who underwent a total of 3034 intradural cranial surgeries. Surprisingly, only four of the included articles reported their definition of CSF leakage. The overall CSF leakage rate was 4.4% (95% CI 2.6 to 7.3%). The odds of CSF leakage were significantly greater for craniectomy as opposed to craniotomy (OR 4.7, 95% CI 1.7 to 13.4) and infratentorial as opposed to supratentorial surgery (OR 5.9, 95% CI 1.7 to 20.6). The odds of CSF leakage were significantly lower for duraplasty use versus no duraplasty (OR 0.41 95% CI 0.2 to 0.9).
Conclusion
The overall CSF leakage rate after intradural cranial surgery in the pediatric population is 4.4%. Risk factors are craniectomy and infratentorial surgery. Duraplasty use is negatively associated with CSF leak. We suggest defining a CSF leak as “leakage of CSF through the skin,” as an unambiguous definition is fundamental for future research.
... [1][2][3][4][5][6] Although in posterior fossa tumor, tumor removal can restore CSF circulation, 10-30% of patients tend to experience persistent hydrocephalus following posterior fossa resection. [4,5,[7][8][9] The patients may present with signs and symptoms of increased intracranial pressure from hydrocephalus (headache, nausea/vomiting, vertigo, unsteady gait, diplopia, papilledema, etc.), which affect the patient's life quality and may result in a prolonged hospital stay. [2,10] Fourth ventricle tumors, in particular, present a high rate of postoperative hydrocephalus because of the compression of tumor to the cerebrospinal fluid (CSF) pathways. ...
... [13,14] The lack of cases limits clinical experience data on the spectrum of pathologies in this region. [2][3][4][5][6][7][8][9][15][16][17][18] We aimed to sought factors, which might be correlated with the development of persistent hydrocephalus following resection of fourth ventricle tumors to evaluate the indication for postoperative CSF drainage. ...
Background and aim
Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure.
Materials and methods
We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis.
Results
A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235–896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016–0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor.
Conclusion
Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.
... Our findings are consistent with the results of Steinbok et al., where pseudomeningocele/CSF leaks were more commonly seen in midline located tumors compared to off midline tumors [62]. In contrast, Hosainey et al. studied CSF disturbances in all intracranial tumors in pediatric patients (n = 381) and concluded that younger age was significantly associated with CSF leak [94]. Our results may be explained by the higher number of patients operated on above the age of 3 years (n = 42), versus those who are lesser than 3 years of age (n = 22). ...
Background
Among all childhood cancers, brain tumors are second only to leukemia in incidence and are the most common solid pediatric tumors. More than 60% of pediatric brain tumors are infra-tentorial. The first-line treatment for most infra-tentorial tumors in pediatric patients is surgical resection, with the goal of gross-total resection, relief of symptoms and hydrocephalus, and increased survival. The proximity to the fourth ventricle, and therefore, the cerebrospinal fluid (CSF) pathways, predisposes children with posterior fossa tumors to the development of obstructive hydrocephalus and multiple other co-morbidities pre and post-surgery.
Objectives
This study aims to present our series of pediatric posterior fossa tumor surgeries in the Neurosurgical Department at the American University of Beirut Medical Center(AUBMC) and perform internal quality control for our single-institution consecutive series as one of the largest referral and tertiary care centers in the region. The second purpose of this retrospective study is to weigh the risks of surgery against the presumed advantages and to have specific knowledge about the complication rates, especially those related to the CSF pathway, comparing our results to those in the literature.
Methods
All pediatric patients (< 18 years of age), referred to our center from different regions in the middle east, and surgically treated for a posterior fossa tumor from June 2006 to June 2018 at the American University of Beirut Medical Center were included. A thorough review of all medical charts was performed to validate all the database records.
Results
The patient sample consisted of 64 patients having a mean age of 6.19 ± 4.42 years and 59.37% of whom were males. The most common tumor pathology was pilocytic astrocytoma (40.62%) followed by medulloblastoma (35.93%) and ependymoma. The most common type of tumor that was seen in patients that developed mutism postoperatively (n = 6, 9.37%) was medulloblastoma (n = 4, 66.66%). In this patient sample, 12.28% (n = 7) of the patients developed hydrocephalus postoperatively.Midline tumors were more associated with the development of mutism(OR = 4.632, p = 0.306) and hydrocephalus (OR = 5.056, p = 0.135) postoperatively, albeit not statistically significantly.The presence of a preoperative shunt was shown to be protective against the development of CSF leak (OR = 0.636, p = 0.767), as none of the patients that came in with CSF diversion developed a CSF leak after their surgery.
Conclusion
This study from a single center experience accompanied by a thorough literature review sheds light on the complications frequently encountered after posterior fossa tumor surgery in children. These included transient cerebellar mutism, CSF leak, and hydrocephalus as seen in some of our patients. Our findings highlight the need for prospective studies with well-defined protocols directed at assessing novel ways and approaches to minimize the risk of these complications.
... 34 Supratentorial brain tumors involve critical areas of the diencephalon and cerebrum, and resections of these areas are associated with complications such as olfactory dysfunction, hydrocephalus, hematoma, and cerebrospinal fluid leak. [35][36][37][38] Previous studies investigating the role of gender in brain tumor resection have not systematically mediated for the contributing effect of other SDOH, resulting in potentially significant confounding bias. The present study is the first to use a coarsened exact matched methodology to isolate for the target variable and assess the role of gender on outcomes in patients who differ in gender but are otherwise identical in several key characteristics. ...
... The higher rates of perioperative morbidity and mortality are likely because of the proximity of supratentorial brain tumors to vital neurologic structures, leading to common complications after resection such as cerebrospinal fluid leak, hematoma, seizures, hydrocephalus, and permanent neurologic deficits in the language, sensory, and motor areas. [35][36][37][38] Novel solutions for reducing postoperative adverse outcomes are needed. The present study investigated the impact of gender on shortterm outcomes in a population of 1943 patients after supratentorial brain tumor resection. ...
Background
Gender is a complex social determinant of health impacted by both social and biological factors. There is a need to investigate the effect of gender on outcomes, in the absence of confounding characteristics, in order to mitigate disparities in care.
Methods
1,970 consecutive patients at a university health system undergoing non-meningioma supratentorial brain tumor resection over a six-year period (6/9/2013 – 4/26/2019) were analyzed retrospectively. Coarsened Exact Matching was employed to match patients on demographic factors including history of prior surgery, median household income, and race, amongst others. Outcomes assessed included readmission, ED visit, unplanned reoperation, and mortality within 30 days of surgery. Regression analysis was performed amongst pre-matched population and between the matched cohorts with significance set at a p-value < 0.05.
Results
Within the matched population, no significant difference was observed between male and female patients in any of the recorded outcomes after non-meningioma supratentorial brain tumor resection, including readmission, ED evaluation, unplanned reoperation, and mortality within 30 days of resection (p = 0.28 – 0.85). Similarly, no significant difference was found in any of the morbidity and mortality outcomes in the pre-matched regression analysis (p = 0.10 – 0.70).
Conclusion
When gender is isolated from race, household economics, and other key factors, it does not appear to independently predict morbidity or mortality in the short-term post-operative window following supratentorial brain tumor resection. Future studies should investigate the impact of gender in longer follow-up and its interrelation with other social determinants of health contributing to outcome disparity.
