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Adjunct Perioperative Factors Impacting Brain Metastasis Patient’s Morbidity and Mortality

Genevieve Ening, Kirsten Schmieder, Christopher Brenke

Background: Brain metastasis (BM), occur more frequently as therapy for primary tumors improve and patients survive longer. Neurosurgeons are hence challenged with perioperative patient management and adequate stratification. This study aimed at identifying additional preoperative stratification parameters impacting patient morbidity and mortality.

Methods and findings: A retrospective review of 100 adult patients operated for BM within 18 months at a single institution was conducted. Clinical records of patients were evaluated for outcome associating factors, recording demographics, tumor characteristics and treatment parameters. Survival analysis was performed by the Kaplan-Meier-method. Parameters affecting perioperative mortality and morbidity were examined using univariate and multivariate cox proportionalhazards regression models. For the 43 female and 57 male patients the median age was 64 years (range 45- 82). Median body mass index (BMI) was 24.7 kg/m2 (range 14.7-39.9). Mean serum C-reactive protein (CRP) level was 2 ± 0.3 mg/L with 43% of patients having elevated levels. In-hospital mortality rate was 4% and complication rate was 29% (41 cases; 9 surgical, 11 neurological and 21 medical). Recurrence rated with 8%. Significant variables for improved survival were non-occurrence of complications (p=0.001), age <65 years (p=0.024), and solitary BM (p=0.007). This reflected in high recursive partitioning analysis (RPA) classes (p<0.0001) significantly impacting poor survival. RPA class (p<0.001, OR 3.52, 95% CI 1.80-6.90) and complication occurrence (p=0.05, OR 2.36, 95% CI 1.30-4.28) independently impacted poor survival. None of the assessed parameters including BMI, CRP and Charlson-comorbidity-index (CCI) proved significantly associated with complication occurrence.

Conclusions: Our results support the prognostic significance of the RPA classification and proves complication occurrence to significantly impact poor survival. CCI, BMI and CRP did not significantly impact mortality or morbidity. Hence, they may not be eligible parameters for selecting surgical patients.