Newly Published
Perioperative Medicine  |   September 2018
Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy: A Multicenter Observational Study
Author Notes
  • From the Anesthesia and Critical Care Department, Hôtel Dieu, University Hospital of Nantes, Nantes, France (R.C., A.G., K.A.); Anesthesia and Critical Care Department, Hôpital La Timone, University Hospital of Marseille, Marseille, France (N.B., T.T.); Anesthesia and Critical Care Department, Hôpital Pierre-Paul Ricquet, University Toulouse 3–Paul Sabatier, Toulouse, France (M.S., T.G., V.A.); Anesthesia and Critical Care Department, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France (C.P.-B., J.J.); Anesthesia and Critical Care Department, Hôpital Pontchaillou, University Hospital of Rennes, and University of Rennes 1, Rennes, France (H.B., S.V., M.G.); Anesthesia and Critical Care Department, Hôpital de Hautepierre, University Hospital of Strasbourg, Strasbourg, France (J.P., D.V.); Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital of Nantes, Saint-Herblain, France (K.L., Y.B., B.R.); Institut du Thorax, Institut National de la Santé et de la Recherche Médicale, UMR1087, Institut de Recherche en Santé, University Hospital of Nantes, Nantes, France (B.R.); Plateforme de Méthodologie et de Biostatistique, Cellule de Promotion de la Recherche Clinique, University Hospital of Nantes, Nantes, France (A.L.T., F.F.); Institut National de la Santé et de la Recherche Médicale MethodS for Patients-centered outcomes and HEalth REsearch U1246, Unité de Formation de Recherche des Sciences Pharmaceutiques, University of Nantes, University of Tours, Nantes, France (F.F.); and Laboratoire Unité propre de l'enseignement supérieur et de recherche EA 3826, University Hospital of Nantes, Nantes, France (K.A.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article has been presented at the National Congress of the French Society of Anesthesiology and Critical Care (SFAR) meeting, in Paris, France, September 23–24, 2016.
    Part of the work presented in this article has been presented at the National Congress of the French Society of Anesthesiology and Critical Care (SFAR) meeting, in Paris, France, September 23–24, 2016.×
  • Submitted for publication December 1, 2017. Accepted for publication August 1, 2018.
    Submitted for publication December 1, 2017. Accepted for publication August 1, 2018.×
  • Acknowledgments: The authors thank Anne-Sophie Crouzet and Laurence Pacaud, both research nurses in the Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital of Nantes, Saint-Herblain, France; and Delphine Flattres-Duchaussoy and Cécilia LeBel, both assistant researchers in the Anesthesia and Critical Care Department, Hôtel Dieu, University Hospital of Nantes, Nantes, France, for their precious help in the logistics of this study.
    Acknowledgments: The authors thank Anne-Sophie Crouzet and Laurence Pacaud, both research nurses in the Anesthesia and Critical Care Department, Hôpital Laennec, University Hospital of Nantes, Saint-Herblain, France; and Delphine Flattres-Duchaussoy and Cécilia LeBel, both assistant researchers in the Anesthesia and Critical Care Department, Hôtel Dieu, University Hospital of Nantes, Nantes, France, for their precious help in the logistics of this study.×
  • The authors also appreciate the reactivity, methodologic help, and logistics of the Société Française d’Anesthésie-Réanimation Research Network and all of the doctors and nurses involved in data collection at all sites.
    The authors also appreciate the reactivity, methodologic help, and logistics of the Société Française d’Anesthésie-Réanimation Research Network and all of the doctors and nurses involved in data collection at all sites.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: Dr. Asehnoune received payments from FRESENIUS (Sèvres, France), Laboratoire français du fractionnement et des biotechnologies (Courtaboeuf, France), and BAXTER (Guyancourt, France).
    Competing Interests: Dr. Asehnoune received payments from FRESENIUS (Sèvres, France), Laboratoire français du fractionnement et des biotechnologies (Courtaboeuf, France), and BAXTER (Guyancourt, France).×
  • *Members of the Société Française d’Anesthésie-Réanimation (SFAR) Research Network are listed in the appendix.
    Members of the Société Française d’Anesthésie-Réanimation (SFAR) Research Network are listed in the appendix.×
  • Correspondence: Address correspondence to Dr. Asehnoune: Department of Anesthesia and Critical Care, Hôtel Dieu, 1 Place Alexis Ricordeau, 44093 Nantes Cedex 9, France. Karim.asehnoune@chu-nantes.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems / Neurosurgical Anesthesia
Perioperative Medicine   |   September 2018
Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy: A Multicenter Observational Study
Anesthesiology Newly Published on September 18, 2018. doi:10.1097/ALN.0000000000002426
Anesthesiology Newly Published on September 18, 2018. doi:10.1097/ALN.0000000000002426
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • The authors developed a score for predicting the risk of postoperative complications

What This Article Tells Us That Is New:

  • The score was developed from 1,094 patients and validated in 830 patients from six French hospitals

  • Severe complications occurred in about 11% of each cohort

  • The positive predictive value was poor, but the negative prediction value was excellent and might be used to identify patients who do not need critical care

Background: Craniotomy for brain tumor displays significant morbidity and mortality, and no score is available to discriminate high-risk patients. Our objective was to validate a prediction score for postoperative neurosurgical complications in this setting.

Methods: Creation of a score in a learning cohort from a prospective specific database of 1,094 patients undergoing elective brain tumor craniotomy in one center from 2008 to 2012. The validation cohort was validated in a prospective multicenter independent cohort of 830 patients from 2013 to 2015 in six university hospitals in France. The primary outcome variable was postoperative neurologic complications requiring in–intensive care unit management (intracranial hypertension, intracranial bleeding, status epilepticus, respiratory failure, impaired consciousness, unexpected motor deficit). The least absolute shrinkage and selection operator method was used for potential risk factor selection with logistic regression.

Results: Severe complications occurred in 125 (11.4%) and 90 (10.8%) patients in the learning and validation cohorts, respectively. The independent risk factors for severe complications were related to the patient (Glasgow Coma Score before surgery at or below 14, history of brain tumor surgery), tumor characteristics (greatest diameter, cerebral midline shift at least 3 mm), and perioperative management (transfusion of blood products, maximum and minimal systolic arterial pressure, duration of surgery). The positive predictive value of the score at or below 3% was 12.1%, and the negative predictive value was 100% in the learning cohort. In–intensive care unit mortality was observed in eight (0.7%) and six (0.7%) patients in the learning and validation cohorts, respectively.

Conclusions: The validation of prediction scores is the first step toward on-demand intensive care unit admission. Further research is needed to improve the score’s performance before routine use.