Lisa Millgård Sagberg, Christina Drewes, Asgeir S. Jakola and Ole Solheim
In the absence of practical and reliable prognostic tools in intracranial tumor surgery, decisions regarding patient selection, patient information, and surgical management are usually based on neurosurgeons' clinical judgment, which may be influenced by personal experience and knowledge. The objective of this study was to assess the accuracy of the operating neurosurgeons' predictions about patients' functional levels after intracranial tumor surgery.
In a prospective single-center study, the authors included 299 patients who underwent intracranial tumor surgery between 2011 and 2015. The operating neurosurgeons scored their patients' expected functional level at 30 days after surgery using the Karnofsky Performance Scale (KPS). The expected KPS score was compared with the observed KPS score at 30 days.
The operating neurosurgeons underestimated their patients' future functional level in 15% of the cases, accurately estimated their functional levels in 23%, and overestimated their functional levels in 62%. When dichotomizing functional levels at 30 days into dependent or independent functional level categories (i.e., KPS score < 70 or ≥ 70), the predictive accuracy was 80%, and the surgeons underestimated and overestimated in 5% and 15% of the cases, respectively. In a dichotomization based on the patients' ability to perform normal activities (i.e., KPS score < 80 or ≥ 80), the predictive accuracy was 57%, and the surgeons underestimated and overestimated in 3% and 40% of cases, respectively. In a binary regression model, the authors found no predictors of underestimation, whereas postoperative complications were an independent predictor of overestimation (p = 0.01).
Operating neurosurgeons often overestimate their patients' postoperative functional level, especially when it comes to the ability to perform normal activities at 30 days. This tendency to overestimate surgical outcomes may have implications for clinical decision making and for the accuracy of patient information.
Christina Drewes, Lisa Millgård Sagberg, Asgeir Store Jakola and Ole Solheim
Traditionally, the dominant (usually left) cerebral hemisphere is regarded as the more important one, and everyday clinical decisions are influenced by this view. However, reported results on the impact of lesion laterality are inconsistent in the scarce literature on quality of life (QOL) in patients with brain tumors. The authors aimed to study which cerebral hemisphere is the most important to patients with intracranial tumors with respect to health-related QOL (HRQOL).
Two hundred forty-eight patients with unilateral, unifocal gliomas or meningiomas scheduled for primary surgery were included in this prospective cohort study. Generic HRQOL was measured using the EQ-5D-3L questionnaire preoperatively and after 4–6 weeks. Cross-sectional and longitudinal analyses of data were performed.
Tumor volumes were significantly larger in right-sided tumors at diagnosis, and language or speech problems were more common in left-sided lesions. Otherwise, no differences existed in baseline data. The median EQ-5D-3L index was 0.73 (range −0.24 to 1.00) in patients with right-sided tumors and 0.76 (range −0.48 to 1.00) in patients with left-sided tumors (p = 0.709). Due to the difference in tumor volumes at baseline, histopathology and tumor volumes were matched in 198 patients. EQ-5D-3L index scores in this 1:1 matched analysis were 0.74 (range −0.7 to 1.00) for patients with right-sided and 0.76 (range −0.48 to 1.00) for left-sided lesions (p = 0.342). In the analysis of longitudinal data, no association was found between tumor laterality and postoperative EQ-5D-3L index scores (p = 0.957) or clinically significant change in HRQOL following surgery (p = 0.793).
In an overall patient-reported QOL perspective, tumor laterality does not appear to be of significant importance for generic HRQOL in patients with intracranial tumors. This may imply that right-sided cerebral functions are underestimated by clinicians.
Paolo Ferroli and Morgan Broggi
Christina Drewes, Lisa Millgård Sagberg, Asgeir Store Jakola, Sasha Gulati and Ole Solheim
Published outcome reports in neurosurgical literature frequently rely on data from retrospective review of hospital records at discharge, but the sensitivity and specificity of retrospective assessments of surgical morbidity is not known. The aim of this study was to elucidate the sensitivity and specificity of retrospective assessment of morbidity after intracranial tumor surgery by comparing it to patient-reported outcomes at 30 days.
In 191 patients who underwent surgery for the treatment of intracranial tumors, we evaluated newly acquired neurological deficits within the motor, language, and cognitive domains. Traditional retrospective discharge data were collected by review of hospital records. Patient-reported data were obtained by structured phone interviews at 30 days after surgery. Data on perioperative medical and surgical complications were obtained from both hospital records and patient interviews conducted 30 days postoperatively.
Sensitivity values for retrospective review of hospital records as compared with patient-reported outcomes were 0.52 for motor deficits, 0.4 for language deficits, and 0.07 for cognitive deficits. According to medical records, 158 patients were discharged with no new or worsened deficits, but only 117 (74%) of these patients confirmed this at 30 days after surgery. Specificity values were high (0.97–0.99), indicating that new deficits were unlikely to be found by retrospective review of hospital records at discharge when the patients did not report any at 30 days. Major perioperative complications were all identified through retrospective review of hospital records.
Retrospective assessment of medical records at discharge from hospital may greatly underestimate the incidence of new neurological deficits after brain tumor surgery when compared with patient-reported outcomes after 30 days.
Ranjith Babu and John H. Sampson