Prädiktiver Score zur Vorhersage postoperativer Komplikationen nach elektiven Kraniotomien

Postoperative complications that need to be monitored after elective craniotomies occur in about 2% of cases. In most neurosurgical departments, an elective craniotomy is routinely followed by a postoperative monitoring in an intensive or intermediate care unit (ICU; IMC). However, there is no systematic allocation to this procedure; patients at risk postoperative complications are not monitored as a priority.The aim of this study was to develop a prediction score for postoperative complications after elective craniotomies and to redefine the monitoring algorithm.

Data acquisition was performed as a retrospective analysis of a single center. Patients who underwent elective craniotomy between 2018 and 2021 were included. Demographic data, diagnosis, location of the pathology (infra-/ supratentorial), American Society of Anaesthesiologists (ASA)-score, Charlson comorbidity index (CCI), duration of surgery, blood loss, complications (hemorrhage, respiratory failure, deterioration of neurological status), and type and duration of monitoring were analyzed. The score was calibrated and validated internally for predictive reliability.

860 consecutive patients (376 male, 484 female) with a mean age of 60.6 years (range: 19-93 years) were included. Forty-three patients experienced a postoperative adverse event that was detected by close monitoring and required intensive care monitoring/treatment. The main predictors for postoperative complications were CCI (OR=1.19, CI95%=1.04-1.36), operative time (OR=45.9, CI95%=10.01-229.3), location of pathology (OR=1.68, CI95%=0.9-3.1) and ASA score (OR=1.1, CI95%=1.01-1.2). The score was based on the above characteristics, the score weight was calculated as shown in the attached figure. The discriminatory value for clinical outcomes of the established score achieved an AUC of 0.8 (CI95%=0.76-0.86).

This score including CCI, ASA and the location of the pathology provides a practical approach for individual risk assessment of patients undergoing elective craniotomy. Dependent on the reached score a preoperative risk evaluation can grade the risk for postoperative complications. Postoperative monitoring capacities should preferably be assigned to elaborated high-risk cases. Patients with a low risk score could be transferred to the normal ward as fast track after a few hours to make optimum use of valuable capacity.