National Outcomes and Factors Associated with 30-Day Mortality in Malignant Brain Tumor Surgery: A Retrospective Cohort NSQIP Analysis of Health System Resilience.

Abstract

This study investigates whether the incidence of 30-day postoperative mortality following supratentorial primary malignant brain tumor (SPMBT) surgery differed significantly during the COVID-19 pandemic (2020-2021) compared to the pre-pandemic era (2016-2019). This retrospective cohort study utilized the National Surgical Quality Improvement Program (NSQIP) database to identify adult patients who underwent craniotomy for SPMBT resection. We compared 30-day mortality rates and analyzed risk factors associated with mortality in both periods using univariable and multivariable logistic regression. The study included 13,716 patients (8,830 pre-pandemic; 4,886 during the pandemic). Overall 30-day mortality rates were 3.1% pre-pandemic and 2.6% during the pandemic (p=0.087). Multivariable analysis identified time period, age, disseminated cancer, increased preoperative white blood cell count, and postoperative complications (pneumonia, ventilation >48 hours, and stroke/CVA) as factors significantly associated with mortality. Despite an expected increased odds of mortality during the COVID-19 period, surgery during the pandemic was associated with lower odds of mortality (OR 0.70, 95% CI 0.55-0.88, p=0.0027) in multivariable logistic regression. Contrary to our hypothesis, 30-day mortality was lower during the COVID-19 pandemic. Patient-specific factors and postoperative complications remain the primary drivers of mortality regardless of the healthcare era. These results highlight the importance of perioperative risk mitigation and provide hypothesis-generating data for understanding how neurosurgical care can be maintained during periods of high demand that stress the healthcare system to its capacity.