Perioperative Care and Outcomes of Patients with Brain Tumors Undergoing Elective Craniotomy: Experience from an Ethiopian Tertiary-Care Hospital

Abstract

To describe patients, perioperative care, and outcomes undergoing supratentorial and infratentorial craniotomy for brain tumor resection in a tertiary-care hospital in Ethiopia. A retrospective cohort study of patients consecutively admitted between January 1, 2021, and December 31, 2021, was performed. We characterized patients, perioperative care, and outcomes. The final sample comprised 153 patients; 144 (94%) 18 years and over, females (n= 48, 55%) with primarily American Society of Anesthesiologists physical class II (n=97 (63.4%) who underwent supratentorial (n= 114, 75%), or infratentorial (n=39, 25%) tumor resection. Patients were routinely admitted (95%) to floor/wards before craniotomy; Inhaled anesthetic (isoflurane 88%/halothane 12%) was used for maintenance of general anesthesia, 3) Propofol (n=93, 61%; n=72), mannitol (n=73, 48%, n=54l), and cerebrospinal fluid drain (n=28, 18%, were used facilitate intraoperative brain relaxation, while the use of hyperventilation was rate (n=1). The average estimated blood loss was 1040+727 ml; 37 (24%) patients received tranexamic acid, and 57 (37%) received a blood transfusion. Factors associated with extubation were a) infratentorial tumor location: relative risk RR 0.45 (95% CI 0.29-0.69), preoperative hydrocephalus: RR 0.51, (95% CI 0.34-0.79), shorter total anesthesia duration: 277.8+8.8 vs. 426.77+13.1 minutes, p < 0.0001, lower estimated blood loss: 897+68 ml vs. 1361.7+100 ml, p=0.0002, and CSF drainage to facilitate brain relaxation: RR 0.52, 95% CI 0.32-0.84). Approximately one in ten patients experienced postoperative obstructive hydrocephalus, surgical site infections, or pneumonia. These findings suggest that certain factors may impact patient outcomes following craniotomy for tumor resection. By identifying these factors, healthcare providers may be better equipped to develop individualized treatment plans and improve patient outcomes. Additionally, the study highlights the importance of postoperative monitoring and management to prevent complications.