Incidence, causes, and predictors of unplanned reoperation after craniotomy for brain metastases and its impact on patient outcomes

Abstract

Background: Unplanned reoperation after craniotomy is a complication that can significantly affect patient outcomes. However, the incidence, causes, predictors, and outcomes of unplanned reoperation after craniotomy for brain metastases (BM) remain unclear.

Materials and methods: This retrospective, single-center study analyzed 500 consecutive patients who underwent elective craniotomy for BM between January 2014 and June 2024. Patients who required an unplanned surgical intervention within 30 days of the initial craniotomy were identified. Predictors and outcomes of unplanned reoperations were evaluated.

Results: The incidence of major unplanned reoperation was 8.4% (42/500). The most common causes for major unplanned reoperations were postoperative hemorrhage (40.5%) and hydrocephalus (26.2%). Factors associated with unplanned reoperation included uncontrolled primary tumors (adjusted odds ratio [aOR]: 2.53, 95%CI: 1.24-5.16, p = 0.011), 100,000 < platelet count ≤ 150,000 (aOR: 2.29, 95%CI: 1.35-3.89, p = 0.002), platelet count ≤ 100,000 (aOR: 16.10, 95%CI: 2.46-102.2, p = 0.001), multiple BM (aOR: 4.06, 95%CI: 1.94-8.45, p < 0.001), and deep tumor location (aOR: 2.42, 95%CI: 1.19-4.87, p = 0.014). Major unplanned reoperation was associated with a higher rate of non-home discharge (23.8% vs. 11.8%, absolute risks difference [ARD]: 0.12, 95%CI: 0.01-0.23, p = 0.026) and greater functional decline at 6 months measured by KPS (64.3% vs. 27.3%, ARD 0.37, 95%CI: 0.22-0.52, p < 0.001). In the Kaplan-Meier analysis, unplanned reoperation was associated with reduced median overall survival (15.6 vs 17.1 months, p = 0.017).

Conclusions: Uncontrolled primary cancer, lower platelet count, multiple BM lesions, and deep tumor location were associated with unplanned reoperation after BM surgery.Patients with unplanned reoperations were associated with worse functional outcomes.

Keywords: brain metastasis; craniotomy; postoperative complications; surgical outcomes; survival; unplanned reoperation.