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Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis.
J Neurosurg. 2017 Mar; 126(3):677-689.JN

Abstract

OBJECTIVE

Although there is a growing body of research highlighting the negative impact of obesity and malnutrition on surgical outcomes, few studies have evaluated these parameters in patients undergoing intracranial surgery. The goal of this study was to use a national registry to evaluate the association of body mass index (BMI) and hypoalbuminemia with 30-day outcomes after craniotomy for tumor.

METHODS

Adult patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry. Patients were stratified by body habitus according to the WHO classification, as well as by preoperative hypoalbuminemia (< 3.5 g/dl). Multivariable logistic regression evaluated the association of body habitus and hypoalbuminemia with 30-day mortality, complications, and discharge disposition. Covariates included patient age, sex, race or ethnicity, tumor histology, American Society of Anesthesiology class, preoperative functional status, comorbidities (including hypertension and diabetes mellitus), and additional preoperative laboratory values.

RESULTS

Among the 11,510 patients included, 28.7% were classified as normal weight (BMI 18.5-24.9 kg/m2), 1.9% as underweight (BMI < 18.5 kg/m2), 33.4% as overweight (BMI 25.0-29.9 kg/m2), 19.1% as Class I obese (BMI 30.0-34.9 kg/m2), 8.3% as Class II obese (BMI 35.0-39.9 kg/m2), 5.5% as Class III obese (BMI ≥ 40.0 kg/m2), and 3.1% had missing BMI data. In multivariable regression models, body habitus was not associated with differential odds of mortality, postoperative stroke or coma, or a nonroutine hospital discharge. However, the adjusted odds of a major complication were significantly higher for Class I obese (OR 1.28, 99% CI 1.01-1.62; p = 0.008), Class II obese (OR 1.53, 99% CI 1.13-2.07; p < 0.001), and Class III obese (OR 1.67, 99% CI 1.19-2.36; p < 0.001) patients compared with those of normal weight; a dose-dependent effect was seen, with increased effect size with greater adiposity. The higher odds of major complications was primarily due to significantly increased odds of a venous thromboembolism in overweight and obese patients, as well as of a surgical site infection in those with Class II or III obesity. Additionally, 41.0% of patients had an albumin level ≥ 3.5 g/dl, 9.6% had hypoalbuminemia, and 49.4% had a missing albumin value. Hypoalbuminemia was associated with significantly higher odds of mortality (OR 1.91, 95% CI 1.41-2.60; p < 0.001) or a nonroutine hospital discharge (OR 1.46, 95% CI 1.21-1.76; p < 0.001).

CONCLUSIONS

In this National Surgical Quality Improvement Program analysis evaluating patients who underwent craniotomy for tumor, body habitus was not associated with differential mortality or neurological complications. However, obese patients had increased odds of a major perioperative complication, primarily due to higher rates of venous thromboembolic events and surgical site infections. Preoperative hypoalbuminemia was associated with increased odds of mortality and a nonroutine hospital discharge, suggesting that serum albumin may have utility in stratifying risk preoperatively in patients undergoing craniotomy.

Authors+Show Affiliations

Department of Neurosurgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts; and.Harvard Medical School, Boston, Massachusetts; and.Department of Neurosurgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts; and.Harvard Medical School, Boston, Massachusetts; and.Department of Neurosurgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts; and.Department of Neurosurgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts; and. School of Public Health, Yale University, New Haven, Connecticut.Department of Neurosurgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts; and.Department of Neurosurgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts; and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27203139

Citation

Dasenbrock, Hormuzdiyar H., et al. "Body Habitus, Serum Albumin, and the Outcomes After Craniotomy for Tumor: a National Surgical Quality Improvement Program Analysis." Journal of Neurosurgery, vol. 126, no. 3, 2017, pp. 677-689.
Dasenbrock HH, Liu KX, Chavakula V, et al. Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. J Neurosurg. 2017;126(3):677-689.
Dasenbrock, H. H., Liu, K. X., Chavakula, V., Devine, C. A., Gormley, W. B., Claus, E. B., Smith, T. R., & Dunn, I. F. (2017). Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Journal of Neurosurgery, 126(3), 677-689. https://doi.org/10.3171/2016.2.JNS152345
Dasenbrock HH, et al. Body Habitus, Serum Albumin, and the Outcomes After Craniotomy for Tumor: a National Surgical Quality Improvement Program Analysis. J Neurosurg. 2017;126(3):677-689. PubMed PMID: 27203139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body habitus, serum albumin, and the outcomes after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. AU - Dasenbrock,Hormuzdiyar H, AU - Liu,Kevin X, AU - Chavakula,Vamsidhar, AU - Devine,Christopher A, AU - Gormley,William B, AU - Claus,Elizabeth B, AU - Smith,Timothy R, AU - Dunn,Ian F, Y1 - 2016/05/20/ PY - 2016/5/21/pubmed PY - 2019/8/20/medline PY - 2016/5/21/entrez KW - ACS = American College of Surgeons KW - ASA = American Society of Anesthesiologists KW - BMI = body mass index KW - NSQIP KW - NSQIP = National Surgical Quality Improvement Program KW - National Surgical Quality Improvement Program KW - albumin KW - body habitus KW - body mass index KW - brain tumor KW - craniotomy KW - nutrition KW - obesity KW - oncology KW - outcomes SP - 677 EP - 689 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 126 IS - 3 N2 - OBJECTIVE Although there is a growing body of research highlighting the negative impact of obesity and malnutrition on surgical outcomes, few studies have evaluated these parameters in patients undergoing intracranial surgery. The goal of this study was to use a national registry to evaluate the association of body mass index (BMI) and hypoalbuminemia with 30-day outcomes after craniotomy for tumor. METHODS Adult patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry. Patients were stratified by body habitus according to the WHO classification, as well as by preoperative hypoalbuminemia (< 3.5 g/dl). Multivariable logistic regression evaluated the association of body habitus and hypoalbuminemia with 30-day mortality, complications, and discharge disposition. Covariates included patient age, sex, race or ethnicity, tumor histology, American Society of Anesthesiology class, preoperative functional status, comorbidities (including hypertension and diabetes mellitus), and additional preoperative laboratory values. RESULTS Among the 11,510 patients included, 28.7% were classified as normal weight (BMI 18.5-24.9 kg/m2), 1.9% as underweight (BMI < 18.5 kg/m2), 33.4% as overweight (BMI 25.0-29.9 kg/m2), 19.1% as Class I obese (BMI 30.0-34.9 kg/m2), 8.3% as Class II obese (BMI 35.0-39.9 kg/m2), 5.5% as Class III obese (BMI ≥ 40.0 kg/m2), and 3.1% had missing BMI data. In multivariable regression models, body habitus was not associated with differential odds of mortality, postoperative stroke or coma, or a nonroutine hospital discharge. However, the adjusted odds of a major complication were significantly higher for Class I obese (OR 1.28, 99% CI 1.01-1.62; p = 0.008), Class II obese (OR 1.53, 99% CI 1.13-2.07; p < 0.001), and Class III obese (OR 1.67, 99% CI 1.19-2.36; p < 0.001) patients compared with those of normal weight; a dose-dependent effect was seen, with increased effect size with greater adiposity. The higher odds of major complications was primarily due to significantly increased odds of a venous thromboembolism in overweight and obese patients, as well as of a surgical site infection in those with Class II or III obesity. Additionally, 41.0% of patients had an albumin level ≥ 3.5 g/dl, 9.6% had hypoalbuminemia, and 49.4% had a missing albumin value. Hypoalbuminemia was associated with significantly higher odds of mortality (OR 1.91, 95% CI 1.41-2.60; p < 0.001) or a nonroutine hospital discharge (OR 1.46, 95% CI 1.21-1.76; p < 0.001). CONCLUSIONS In this National Surgical Quality Improvement Program analysis evaluating patients who underwent craniotomy for tumor, body habitus was not associated with differential mortality or neurological complications. However, obese patients had increased odds of a major perioperative complication, primarily due to higher rates of venous thromboembolic events and surgical site infections. Preoperative hypoalbuminemia was associated with increased odds of mortality and a nonroutine hospital discharge, suggesting that serum albumin may have utility in stratifying risk preoperatively in patients undergoing craniotomy. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/27203139/Body_habitus_serum_albumin_and_the_outcomes_after_craniotomy_for_tumor:_a_National_Surgical_Quality_Improvement_Program_analysis_ L2 - https://thejns.org/doi/10.3171/2016.2.JNS152345 DB - PRIME DP - Unbound Medicine ER -