Perioperative Factors Affecting Readmission After Awake Craniotomy: Analysis of 609 Consecutive Cases

Abstract

Awake craniotomy is being used widely for tumors near eloquent areas of the brain and also to facilitate early discharge from the hospital. Although most of the complications occur early in the postoperative period, there is a certain risk of delayed postoperative adverse events after discharge. This study investigated the incidence and the risk factors for postdischarge readmission after awake surgeries. This was a single-institution cohort study of 609 awake craniotomies by one surgeon at Toronto Western Hospital, 2006-2018. Of 609 cases, 562 cases were available for analyses on postoperative readmission. In total, 6.0% (34 cases) were readmitted for medical reasons within 30 days after surgery, including neurologic decline (n= 9, 1.6%), infection at the surgical site (n= 8, 1.4%), followed by seizure (n= 5, 0.9%). Preoperative history of seizure (generalized or complex) was associated with readmission (P= 0.02). Eight of these plus 6 other cases experienced reoperation, and all the cases were due to infection but one (intraventricular hemorrhage). Investigations on correlations between perioperative factors and the reoperation found that redo surgery and findings of hemorrhage on postoperative imaging were significantly associated with reoperation (P= 0.0032, 0.0104 on multivariate analyses, respectively). Although age, malignancy, or preoperative performance status were not related to readmission or reoperation, redo surgery cases and cases with postoperative hematoma were found to be at an increased risk for reoperation. Special attention and care need to be paid to these cases for potential complications after discharge, especially in situations in which patients tend to be discharged early after awake surgeries.