Patient-Reported Outcomes in Elective Cranial Neurosurgery.
BACKGROUND
The role of patient-reported outcomes (PROs) in elective cranial neurosurgery has been poorly studied, and their significance in reflecting complication rates is unclear.


METHODS
A prospective, consecutive, and unselected cohort of 418 adult patients underwent elective intracranial operations between 7 December, 2011 and 31 December, 2012 in Helsinki University Hospital, Finland. The questionnaire-based PROs included subjective postoperative assessments of overall health, cognitive function, and subjective change in functional status. Outcome measures included in-hospital major morbidity (including mortality) and in-hospital overall morbidity. We compared the usefulness of PROs with postoperative modified Rankin Scale (mRS) score.


RESULTS
In univariable analyses, all recorded PROs and 30-day mRS scores ≥ 3 were associated with in-hospital major and overall morbidity. After multivariable analyses, postoperative deterioration of subjective functional status remained associated with in-hospital major morbidity (P = 0.001, odds ratio [OR] 4.9, confidence interval [CI] 1.9-12.0, sensitivity 71%, and specificity 70%) and overall in-hospital morbidity (P < 0.001, OR 5.7, CI 3.1-10.7, sensitivity 59%, and specificity 84%). Postoperatively impaired functional status was more sensitive but less specific in detecting in-hospital major and overall morbidity than the widely used mRS cut-off value of 2. A simple composite score combining the 3 recorded PROs was highly sensitive and specific in detecting in-hospital major (sensitivity 87%, specificity 98%) and overall (sensitivity 72%, specificity 99%) morbidity.


CONCLUSIONS
In elective craniotomy patients, PROs seem promising patient-centered tools for outcomes reporting. Furthermore, neurosurgery-specific patient-reported outcome measures (PROMs) can perhaps be implemented to clinical use to improve patient safety and outcome comparisons in elective cranial neurosurgery.
Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: elina.reponen@hus.fi.
Elina
E
Reponen
Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Hanna
H
Tuominen
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Juha
J
Hernesniemi
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Miikka
M
Korja
D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005387:Finland / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D057566:Self Report; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
Elective craniotomy; In-hospital morbidity; Modified Rankin Scale; Patient-reported outcome; Surgical outcome