title: Preoperative steroid use and the incidence of perioperative complications in patients undergoing craniotomy for definitive resection of a malignant brain tumor.
abstract: We studied the impact of preoperative steroids on 30 day morbidity and mortality of craniotomy for definitive resection of malignant brain tumors. Glucocorticoids are used to treat peritumoral edema in patients with malignant brain tumors, however, prolonged (⩾ 10 days) use of preoperative steroids as a risk factor for perioperative complications following resection of brain tumors has not been studied comprehensively. Therefore, we identified 4407 patients who underwent craniotomy to resect a malignant brain tumor between 2007 and 2012, who were reported in the National Surgical Quality Improvement Program, a prospectively collected clinical database. Metastatic brain tumors constituted 37.5% (n=1611) and primary malignant gliomas 62.5% (n=2796) of the study population. We used logistic regression to assess the association between preoperative steroid use and perioperative complications before and after 1:1 propensity score matching. Patients who received steroids constituted 22.8% of the population (n=1009). In the unmatched cohort, steroid use was associated with decreased length of hospitalization (odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6-0.8), however, the risk for readmission (OR 1.5; 95% CI 1.2-1.8) was increased. In the propensity score matched cohort (n=465), steroid use was not statistically associated with any adverse outcomes. Patients who received steroids were less likely to stay hospitalized for a protracted period of time, but were more likely to be readmitted after discharge following craniotomy. As an independent risk factor, preoperative steroid use was not associated with any observed perioperative complications. The findings of this study suggest that preoperative steroids do not independently compromise the short term outcome of craniotomy for resection of malignant brain tumors.
authors.affiliation: School of Medicine, Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: nima.alan@gmail.com.
authors.forename: Nima
authors.initials: N
authors.lastname: Alan
authors.affiliation: School of Medicine, Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Andreea
authors.initials: A
authors.lastname: Seicean
authors.affiliation: Department of Pulmonary, Critical Care and Sleep Medicine, University Hospitals, Cleveland, OH, USA; Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sinziana
authors.initials: S
authors.lastname: Seicean
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
authors.affiliation: Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000453:epidemiology / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D005910:Glioma / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D011300:Preoperative Care / Q000592:standards* / Q000706:statistics & numerical data; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D013256:Steroids
keywords: Brain metastasis; Malignant gliomas; Morbidity; Mortality; Outcomes; Propensity matching; Surgical resection