PREDICTORS OF MORTALITY AND FUNCTIONAL OUTCOME IN PATIENTS UNDERGOING BRAIN TUMOR SURGERY: A MULTIVARIABLE ANALYSIS

Abstract

Background:

Surgery for brain tumors is associated with high risks of death and low functional outcomes. Risk stratification and informed consent require identification of preoperative and intraoperative predictors.

Methods:

This retrospective cohort study involved all adult patients (≥18 years) who received craniotomy due to primary or metastatic brain tumors at a tertiary neurosurgical center between January 1, 2022, and December 31, 2024. Data on age, gender, preoperative Glasgow Coma Scale (GCS), tumor location (supratentorial vs infratentorial), histology (glioma, meningioma, metastasis), peritumoral edema, midline shift (>5 mm), extent of resection (gross total resection [GTR] vs subtotal/biopsy), ICU stay, and postoperative complications were collected. The primary outcome was 30-day mortality. The secondary outcome was functional status at hospital discharge, assessed using the modified Rankin Scale (mRS; poor outcome was mRS 3-6). Multivariate binary logistic regression was conducted to determine independent predictors.

Results:

A total of 328 patients were included (mean age 48.2 ± 14.5 years; 58% male). Thirty-day mortality was 9.8% (32/328). Poor functional outcome occurred in 27.7% (91/328). On multivariable analysis, independent predictors of mortality were age ≥60 years (adjusted OR 2.81, 95% CI 1.34–5.89, p=0.006), preoperative GCS <9 (adjusted OR 5.24, 95% CI 2.18–12.61, p<0.001), metastatic histology (adjusted OR 3.12, 95% CI 1.45–6.72, p=0.004), absence of GTR (adjusted OR 2.37, 95% CI 1.12–5.02, p=0.024), and postoperative complications (adjusted OR 4.51, 95% CI 2.03–10.02, p<0.001). Similar predictors emerged for poor functional outcome, with additional significance for midline shift and prolonged ICU stay (>3 days).

Conclusion:

The most important independent predictors of mortality and poor functional outcome following brain tumor surgery are advanced age, low GCS, metastatic histology, incomplete resection, and complications. The results endorse the vigorous seeking of GTR where possible and careful perioperative care