Preoperative factors associated with adverse events during awake craniotomy: analysis of 609 consecutive cases
Notice bibliographique
Résumé
OBJECTIVE: Awake surgery is becoming more standard and widely practiced for neurosurgical cases, including but not limited to brain tumors. The optimal selection of patients who can tolerate awake surgery remains a challenge. The authors performed an updated cohort study, with particular attention to preoperative clinical and imaging characteristics that may have an impact on the viability of awake craniotomy in individual patients. METHODS: The authors conducted a single-institution cohort study of 609 awake craniotomies performed in 562 patients. All craniotomies were performed by the same surgeon at Toronto Western Hospital during the period from 2006 to 2018. Analyses of preoperative clinical and imaging characteristics that may have an impact on the viability of awake craniotomy in individual patients were performed. RESULTS: Twenty-one patients were recorded as having experienced intraoperative adverse events necessitating deeper sedation, which made the surgery no longer "awake." In 2 of these patients, conversion to general anesthesia was performed. The adverse events included emotional intolerance of awake surgery (n = 13), air embolism (n = 3), generalized seizure (n = 4), and unexpected subarachnoid hemorrhage (n = 1). Preoperative cognitive decline, dysphasia, and low performance status, as indicated by the Karnofsky Performance Status (KPS) score, were significantly associated with emotional intolerance on univariate analysis. Only a preoperative KPS score < 70 was significantly associated with this event on multivariate analysis (p = 0.0057). Compared with patients who did not experience intraoperative adverse events, patients who did were more likely to undergo inpatient admission (p = 0.0004 for all cases; p = 0.0036 for cases originally planned as day surgery), longer hospital stay (p < 0.0001), and discharge to a location other than home (p = 0.032). CONCLUSIONS: Preoperative physical status was found to be the most decisive factor in predicting whether patients can tolerate an awake craniotomy without complications, whereas older age and history of psychiatric treatment were not necessarily associated with adverse events. Patients who had intraoperative adverse events often had reduced chances of same-day discharge and discharge to home. Preoperative careful selection of patients who are most likely to tolerate the procedure is the key to success for awake surgery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».