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Impact of dedicated neuro-anesthesia management on clinical outcomes in glioblastoma patients: A single-institution cohort study.
Gerritsen, Jasper Kees Wim; Rizopoulos, Dimitris; Schouten, Joost Willem; Haitsma, Iain Kristian; Eralp, Ismail; Klimek, Markus; Dirven, Clemens Maria Franciscus; Vincent, Arnaud Jean Pierre Edouard.
Afiliación
  • Gerritsen JKW; Erasmus Medical Center Rotterdam, Department of Neurosurgery, Rotterdam, The Netherlands.
  • Rizopoulos D; Erasmus Medical Center Rotterdam, Department of Biostatistics, Rotterdam, The Netherlands.
  • Schouten JW; Erasmus Medical Center Rotterdam, Department of Neurosurgery, Rotterdam, The Netherlands.
  • Haitsma IK; Erasmus Medical Center Rotterdam, Department of Neurosurgery, Rotterdam, The Netherlands.
  • Eralp I; Erasmus Medical Center Rotterdam, Department of Anesthesiology, Rotterdam, The Netherlands.
  • Klimek M; Erasmus Medical Center Rotterdam, Department of Anesthesiology, Rotterdam, The Netherlands.
  • Dirven CMF; Erasmus Medical Center Rotterdam, Department of Neurosurgery, Rotterdam, The Netherlands.
  • Vincent AJPE; Erasmus Medical Center Rotterdam, Department of Neurosurgery, Rotterdam, The Netherlands.
PLoS One ; 17(12): e0278864, 2022.
Article en En | MEDLINE | ID: mdl-36512593
BACKGROUND: Glioblastomas are mostly resected under general anesthesia under the supervision of a general anesthesiologist. Currently, it is largely unkown if clinical outcomes of GBM patients can be improved by appointing a neuro-anesthesiologist for their cases. We aimed to evaluate whether the assignment of dedicated neuro-anesthesiologists improves the outcomes of these patients. We also investigated the value of dedicated neuro-oncological surgical teams as an independent variable in both groups. METHODS: A cohort consisting of 401 GBM patients who had undergone resection was retrospectively investigated. Primary outcomes were postoperative neurological complications, fluid balance, length-of-stay and overall survival. Secondary outcomes were blood loss, anesthesia modality, extent of resection, total admission costs, and duration of surgery. RESULTS: 320 versus 81 patients were operated under the anesthesiological supervision of a general anesthesiologist and a dedicated neuro-anesthesiologist, respectively. Dedicated neuro-anesthesiologists yielded significant superior outcomes in 1) postoperative neurological complications (early: p = 0.002, OR = 2.54; late: p = 0.003, OR = 2.24); 2) fluid balance (p<0.0001); 3) length-of-stay (p = 0.0006) and 4) total admission costs (p = 0.0006). In a subanalysis of the GBM resections performed by an oncological neurosurgeon (n = 231), the assignment of a dedicated neuro-anesthesiologist independently improved postoperative neurological complications (early minor: p = 0.0162; early major: p = 0.00780; late minor: p = 0.00250; late major: p = 0.0364). The assignment of a dedicated neuro-oncological team improved extent of resection additionally (p = 0.0416). CONCLUSION: GBM resections with anesthesiological supervision of a dedicated neuro-anesthesiologists are associated with improved patient outcomes. Prospective evidence is needed to further investigate the usefulness of the dedicated neuro-anesthesiologist in different settings.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Glioblastoma Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2022 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Glioblastoma Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2022 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos