Introduction: Multiple simultaneously occurring variables are recognized to have an impact on eventual outcome in patient presenting with neoplastic brain tumors that undergo elective resection. Materials and methods: We conducted a prospective cohort study by consecutively enrolling 78 patients, from the 01 July 2018–30 March 2020, with neoplastic brain tumors that were taken for elective resection. Data collected and analyzed included age, gender, medical co-morbidities, HIV status, admission CD4 count, admission Glasgow Coma Score, length of stay prior to surgery, pre-operative corticosteroid therapy, pre-operative day CD4 count, timing of prophylactic antibiotic administration before skin incision, type of craniotomy, blood loss, duration of surgery, extent of resection, duration of post-operative steroid therapy, histological diagnosis, early nosocomial infection incidence, total length of in-hospital stay, and Glasgow Outcome Score. Results: Regarding subject age, significance was demonstrated with Glasgow Outcome Score (p = 0.04). A clinical trend was suggested where subjects with medical co-morbidities had an unfavourable outcome. A further clinical trend was suggested whereby subjects who were HIV negative, as well as subjects with an absolute CD4 count > 500 cells/mm, tended to have a more favourable outcome than HIV positive subjects, or subjects with an absolute CD4 count < 500 cells/mm. Significance was demonstrated between histological tumor type and Glasgow Outcome Score (p = 0.04). Further trends were suggested where acquiring a day-7 nosocomial infection, and a prolonged length of in-patient stay, both suggested an increased chance of having an unfavourable outcome, although neither demonstrated significance. Conclusion: In our study the primary determinant of patient outcome was histological tumor type, and due to age clustering of specific histological tumor types, subject age was similarly demonstrated to be significantly associated with outcome. Our study furthermore demonstrated that HIV status, and absolute CD4 count, both demonstrated insignificance in relation to outcome.
|Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
|Published - Dec 2020