Neurosurgical focus · 2026
Predictors of hospital length of stay, discharge disposition, and readmission after craniopharyngioma surgery: a multicenter study from the RAPID database.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Tenhoeve Samuel A, Tang Anthony, Orton Cody J, Gautam Diwas, Abdul-Rahman Nana-Hawwa, Silverstein Julie M, Kim Albert H, Evans James J, Barkhoudarian Garni, Fernandez-Miranda Juan C, Pacione Donato R, Kim Won, Bergsneider Marvin, Chicoine Michael R, Zada Gabriel, Kshettry Varun R, Wu Kyle C, Benjamin Carolina G, Van Gompel Jamie, Palit Sandhya R, Catalino Michael P, Mamelak Adam N, Zwagerman Nathan T, Cheok Stephanie K, Little Andrew S, Zenonos Georgios A, Karsy Michael, Morshed Ramin A, Blackburn Spiros L, Mukherjee Debraj, Beer-Furlan Andre, Couldwell William T, Gardner Paul A, Rennert Robert C
Аннотация
OBJECTIVE: Craniopharyngiomas are benign intracranial tumors that can be difficult to manage operatively and often result in postoperative complications and prolonged recovery. Understanding the factors that influence length of stay (LOS), discharge disposition, and readmission can guide perioperative planning and patient counseling. The authors examined the clinical, radiographic, and surgical predictors of extended LOS (eLOS), nonhome discharge, 90-day readmission, and hospitalization ratio (HR) after craniopharyngioma resection using a large, multicenter cohort.
METHODS: A retrospective analysis was conducted using the Registry of Adenomas of the Pituitary and Related Disorders database, encompassing 469 patients who underwent craniopharyngioma resection at 14 US academic centers from 2011 to 2025. Patients were stratified by 4 outcomes: eLOS (> 75th percentile), discharge to home versus skilled nursing facility/rehabilitation, 90-day hospital readmission, and hospitalization ratio (i.e., integration of initial and readmission LOS). Multivariable logistic regression models identified independent predictors for each outcome among patient and surgical variables.
RESULTS: An eLOS (> 10 days) was independently associated with preoperative memory loss (OR 3.75, 95% CI 1.95-7.21), gait imbalance (OR 5.90, 95% CI 1.53-22.70), and postoperative complications (OR 4.07, 95% CI 2.34-7.06). The use of a nasoseptal flap was protective against an eLOS (OR 0.52, 95% CI 0.28-0.93). Discharge to home was predicted by an endoscopic approach (OR 3.87, 95% CI 1.78-8.44) and postoperative intact thirst (OR 2.22, 95% CI 1.05-4.66) and negatively predicted by preoperative diabetes mellitus (OR 0.21, 95% CI 0.09-0.50), LOS (OR 0.87, 95% CI 0.84-0.91), and postoperative cognitive dysfunction (OR 0.30, 95% CI 0.13-0.72). Among 385 patients with follow-up data, a 90-day readmission was independently associated with postoperative complications (OR 5.62, 95% CI 3.12-10.13), preexisting coronary artery disease (OR 4.30, 95% CI 1.46-12.69), and postoperative cognitive dysfunction (OR 3.33, 95% CI 1.76-6.44). A higher HR was associated with diabetes mellitus (unstandardized B 0.059, 95% CI 0.010-0.108, p = 0.02), postoperative complications (unstandardized B 0.054, 95% CI 0.021-0.086, p = 0.001), and postoperative cognitive dysfunction (unstandardized B 0.049, 95% CI 0.006-0.092, p = 0.02). Tumor pathologic subtype and size, prior treatment, extent of resection, and surgeon experience were not directly predictive of outcomes.
CONCLUSIONS: Cognitive and functional status, systemic comorbidities, and postoperative complications, in addition to surgical approach, are important predictors of the early clinical course after craniopharyngioma surgery. Early identification of high-risk patients may help to guide treatment decisions, improve discharge planning, and reduce healthcare utilization.
METHODS: A retrospective analysis was conducted using the Registry of Adenomas of the Pituitary and Related Disorders database, encompassing 469 patients who underwent craniopharyngioma resection at 14 US academic centers from 2011 to 2025. Patients were stratified by 4 outcomes: eLOS (> 75th percentile), discharge to home versus skilled nursing facility/rehabilitation, 90-day hospital readmission, and hospitalization ratio (i.e., integration of initial and readmission LOS). Multivariable logistic regression models identified independent predictors for each outcome among patient and surgical variables.
RESULTS: An eLOS (> 10 days) was independently associated with preoperative memory loss (OR 3.75, 95% CI 1.95-7.21), gait imbalance (OR 5.90, 95% CI 1.53-22.70), and postoperative complications (OR 4.07, 95% CI 2.34-7.06). The use of a nasoseptal flap was protective against an eLOS (OR 0.52, 95% CI 0.28-0.93). Discharge to home was predicted by an endoscopic approach (OR 3.87, 95% CI 1.78-8.44) and postoperative intact thirst (OR 2.22, 95% CI 1.05-4.66) and negatively predicted by preoperative diabetes mellitus (OR 0.21, 95% CI 0.09-0.50), LOS (OR 0.87, 95% CI 0.84-0.91), and postoperative cognitive dysfunction (OR 0.30, 95% CI 0.13-0.72). Among 385 patients with follow-up data, a 90-day readmission was independently associated with postoperative complications (OR 5.62, 95% CI 3.12-10.13), preexisting coronary artery disease (OR 4.30, 95% CI 1.46-12.69), and postoperative cognitive dysfunction (OR 3.33, 95% CI 1.76-6.44). A higher HR was associated with diabetes mellitus (unstandardized B 0.059, 95% CI 0.010-0.108, p = 0.02), postoperative complications (unstandardized B 0.054, 95% CI 0.021-0.086, p = 0.001), and postoperative cognitive dysfunction (unstandardized B 0.049, 95% CI 0.006-0.092, p = 0.02). Tumor pathologic subtype and size, prior treatment, extent of resection, and surgeon experience were not directly predictive of outcomes.
CONCLUSIONS: Cognitive and functional status, systemic comorbidities, and postoperative complications, in addition to surgical approach, are important predictors of the early clinical course after craniopharyngioma surgery. Early identification of high-risk patients may help to guide treatment decisions, improve discharge planning, and reduce healthcare utilization.