Analysis of Operative Mortality Following 800 Consecutive Patients: A Single Surgeon's Experience

Objective: The aim of this study was to evaluate the underlying causes of death following meningioma surgery.

Methods: A retrospective analysis was conducted of 800 consecutive meningioma patients who underwent surgery by a single surgeon (JHL) from 1993 to 2009. Patients were divided into early (within 6 weeks postoperatively) and late (between 6 weeks and 1 year postoperatively) death groups. Their preoperative risk factors and postoperative outcomes were analyzed.

Results: A total of 22 patients (22/800 unique patients, 2.75%) died within 1 year of surgery in this series. Eight died (1.0%) within 6 weeks (Early Group), and an additional 14 died (1.75%) between 6 weeks and 1 year following surgery (Late Group). In the Early Group, three died from operative complications (one medullary infarct, one venous infarct, one malignant cerebral edema), and five died from medical complications (one PE, 2 DIC, one MI, one ARDS). In the Late Group, four died from operative complications (one wound necrosis/fungal infection, one malignant cerebral edema, two arterial infarction), six died from medical complications (three PE, one fungal meningitis, one ventricular tachycardia, one MI), three died from progression of aggressive tumors, and one died from other malignancy. Significant risk factors for postoperative death included symptomatic tumors, large tumor size, poor preoperative medical status, reoperation for recurrence, and older age.

Conclusion: Following meningioma surgery, unexpected medical complications accounted for 50% (11/22) of deaths despite preventative measures taken. Extra care should be given to patients with large or symptomatic tumors, poor medical status, those undergoing reoperation for tumor recurrence, and older patients. These patients should be adequately counseled preoperatively regarding these increased risks of poor outcome.