When are complications following brain tumor surgery detected?
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Objective: To optimize follow-up and surveillance routines after brain tumor surgery knowledge about when different complications occur or are detected is needed. We sought to explore when various postoperative complications are detected after elective craniotomies for intracranial tumors, and to assess the severity of these. Methods: We did a retrospective review of hospital records in 1291 consecutive operations of adult patients (≥18 years) who underwent elective craniotomy for intracranial tumors at St. Olavs University Hospital, from January 2008 to December 2016. Patient medical history, comorbidity, registered outcomes within 30 days and time of detection of complications were registered. The severity and nature (i.e. medical or surgical) of complications were graded using the Landriel classification system (grade I-IV). Results: A total of 681 complications were registered in 451 (34.9%) of the operations within the first 30 days. Surgical and medical complications were seen in 17.7% and 17.3%, respectively. 29.5% experienced mild or moderate complications (grade I-II) and 5.4% experienced severe or fatal complications (grade III-IV). 7.9% of the mild and moderate complications were detected within 24 h and 57.5% within one week with a peak of detection on day two. 5.4% (n=70) of the patients experienced complications within the first postoperative 24 hours, with severe and fatal complications detected in 2.6% (n=31). 45.7% of grade III-IV complications were detected within 24 h and 77.1% were detected within one week, with a peak on day one. Multivariate analysis revealed that Karnofsky Performance Status < 70 and longer duration of surgery were factors associated with developing severe or fatal complications. Conclusion: Using the Landriel classification system mild and moderate complications were more than five times as common as severe and fatal complications. Detection rates, especially for mild and moderate complications, are probably much affected by local routines for surveillance screening, discharge, documentation, and follow up. Of the severe and fatal complications almost half were detected within 24 h post surgery, with cavity hematomas and cerebral infarctions as the most common contributors. Although the evidence is still rather weak, targeted surveillance and screening for complications in patients with risk factors might be safe and more efficient than routine ICU surveillance in all patients.