Incidence of Postoperative Pulmonary Complications in Patients with Brain Tumors: A Systematic Evaluation and Meta-analysis

Jing Zhang; Yixuan Liu; Linyu Hou; Lijun Dou; Mei Ju; Yingying Gao; Xia Huang; Xiaorong Ding

doi:10.6911/WSRJ.202412_10(12).0002

Authors

Jing Zhang
Yixuan Liu
Linyu Hou
Lijun Dou
Mei Ju
Yingying Gao
Xia Huang
Xiaorong Ding

DOI:

https://doi.org/10.6911/WSRJ.202412_10(12).0002

Keywords:

Brain tumor, Pulmonary complications, Incidence.

Abstract

Background: The incidence of postoperative pulmonary complications in patients with brain tumors currently varies widely among studies worldwide. The aim of this study was to clarify the occurrence of postoperative pulmonary complications in patients with brain tumors worldwide. Methods: We searched all relevant studies published before December 31, 2023 from PubMed, Embase, Web of Science, Cochrane Library and four Chinese databases (CNKI, SinoMed, VIP and Wanfang databases). We screened these studies according to the inclusion and exclusion criteria. Two graduate nursing students screened the studies, extracted data, and independently assessed the risk of bias. Study quality was assessed using the Newcastle-Ottawa scale for study quality and meta-analysis was performed using stata 15.0 software. Results:A total of 27 studies were included. The overall incidence rate of postoperative pulmonary complications in patients with brain tumors is 7.5% [95%CI(0.063, 0.087)]. Subgroup analyses based on region, tumor type, and type of pulmonary complication revealed the highest overall incidence rates as follows: 10.1% [95%CI(0.082, 0.119)] in Asia, 12% [95%CI(0.075, 0.166)] for gliomas, and 15% [95%CI(0.109, 0.191)] for specific pulmonary complications. Conclusion: Our findings indicate that the incidence of postoperative pulmonary complications in patients with brain tumors is notably high, underscoring a significant clinical concern. It is imperative to comprehensively monitor various types of pulmonary complications and prioritize the prevention of these complications in patients with malignant brain tumors.

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References

[1] H Sung, J Ferlay, R-L Siegel, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209-249.

[2] M Weller, Le Rhun E, Van den Bent M, et al. Diagnosis and management of complications from the treatment of primary central nervous system tumors in adults. Neuro Oncol, 2023, 25(7): 1200-1224.

[3] Q-T Ostrom, M Price, C Neff, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015-2019. Neuro Oncol, 2022, 24(Suppl 5): v1-v95.

[4] Ibañez-FA Landriel, Hem S, Ajler P, et al. A new classification of complications in neurosurgery. World Neurosurg, 2011, 75(5-6): 709-715, 604-611.

[5] Jammer , N Wickboldt, M Sander, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.

[6] M Longo, V Agarwal. Postoperative Pulmonary Complications Following Brain Tumor Resection: A National Database Analysis. World Neurosurg, 2019, 126e1147-e1154.

[7] A Shander,L-A Fleisher, P-S Barie, et al. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med, 2011, 39(9): 2163-2172.

[8] D-J Cote,A-V Karhade,W-T Burke, et al. Risk factors for post-operative respiratory failure among 94,621 neurosurgical patients from 2006 to 2013: a NSQIP analysis. Acta Neurochir (Wien), 2016, 158(9): 1639-1645.

[9] S Oczkowski, B Ergan,L Bos, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J, 2022, 59(4).

[10] B Rochwerg, L Brochard, M-W Elliott, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J, 2017, 50(2).

[11] D-G Sweet, V-P Carnielli,G Greisen, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology, 2023, 120(1): 3-23.

[12] H-H Viken, I-A Iversen, A Jakola, et al. When Are Complications After Brain Tumor Surgery Detected?. World Neurosurg, 2018, 112E702-E710.

[13] Y-I Li, N Ventura, J-E Towner, et al. Risk factors and associated complications with unplanned intubation in patients with craniotomy for brain tumor. J Clin Neurosci, 2020, 7337-41.

[14] J-M Soto, A-V Nguyen, J-S van Zyl, et al. Outcomes After Supratentorial Craniotomy for Primary Malignant Brain Tumor Resection in Adult Patients: A National Surgical Quality Improvement Program Analysis. World Neurosurg, 2023, 175e780-e789.

[15] M-J Page , J-E McKenzie, P-M Bossuyt, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021, 372n71.

[16] Y-X Fu, Y Yu, Y-D Cui, et al. Factors associated with artificial airway retention after skull base chordoma resection: A retrospective cohort study. Front Neurol, 2022, 13.

[17] T Li, H Liu, X Xu. The Role of Preoperative Pulmonary Function Tests in Evaluating Postoperative Pulmonary Complications in Patients with Intracranial Tumors. Modern Medicine, 2021, 49(5): 562-565.

[18] B Hooda, R-S Chouhan, G-P Rath, et al. Incidence and predictors of postoperative pulmonary complications in patients undergoing craniotomy and excision of posterior fossa tumor. J Anaesth Clin Pharm, 2019, 35(2): 254-260.

[19] J He, S He , Y Zhang, et al. Association between intraoperative steroid and postoperative mortality in patients undergoing craniotomy for brain tumor. Front Neurol, 2023, 141153392.

[20] M Guo, Y Shi, J Gao, et al. Effect of differences in extubation timing on postoperative pneumonia following meningioma resection: a retrospective cohort study. BMC Anesthesiol, 2022, 22(1): 296.

[21] B Huang, Y Ren, X Liu, et al. Does preoperative gamma knife treatment affect the result of microresection of vestibular schwannoma? J Neurooncol, 2022, 160(2): 321-329.

[22] D-W Zhao, F-C Zhao ,X-Y Zhang, et al. Association between postoperative hypoalbuminemia and postoperative pulmonary imaging abnormalities patients undergoing craniotomy for brain tumors: a retrospective cohort study. Sci Rep, 2022, 12(1): 64.

[23] H Ahmeti, C Borzikowsky, D Hollander, et al. Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients. J Neurooncol, 2021, 154(3): 335-344.

[24] Saksham Gupta, Dawood Hassan, Giantini Larsen Alexandra, et al. Surgical and Peri-Operative Considerations for Brain Metastases. Frontiers in Oncology, 2021, 11662943.

[25] Daniel Monden, Raimann Florian-J, Neef Vanessa, et al. Meningioma Surgery in Patients ≥70 Years of Age: Clinical Outcome and Validation of the SKALE Score. Journal of Clinical Medicine, 2021, 10(9).

[26] R-D Alkins,D Newsted, P Nguyen, et al. Predictors of Postoperative Complications in Vestibular Schwannoma Surgery-A Population-Based Study. Otol Neurotol, 2021, 42(7): 1067-1073.

[27] Y Chen, Y-X Lin, Y Pang, et al. Systemic inflammatory response index improves the prediction of postoperative pneumonia following meningioma resection. Chin Med J (Engl), 2020, 134(6): 728-730.

[28] Y Deng, C Wang, Y Zhang. Risk factors for postoperative pneumonia in patients with posterior fossa meningioma after microsurgery. Heliyon, 2020, 6(5): e3880.

[29] M-R Zuo, R-F Liang,M Li, et al. A comprehensive study of risk factors for post-operative pneumonia following resection of meningioma. BMC Cancer, 2019, 19(1): 100.

[30] C Wang, T Li, S Tang, et al. Risk factors for postoperative pneumonia after microsurgery for vestibular schwannoma. Clin Neurol Neurosurg, 2017, 16225-28.

[31] T Oh, M Safaee, M-Z Sun, et al. Surgical risk factors for post-operative pneumonia following meningioma resection. Clin Neurol Neurosurg, 2014, 11876-79.

[32] M-E Sughrue, M-J Rutkowski, G Shangari, et al. Risk factors for the development of serious medical complications after resection of meningiomas. Clinical article. J Neurosurg, 2011, 114(3): 697-704.

[33] S Li, H Huang, Y Yuan, et al. Clinical Distribution and Risk Factors of Postoperative Complications in Primary Intracranial Tumors. Chinese Journal of Neurology and Psychiatry, 2023, 49(11): 654-658.

[34] R Yang, X Hao, C Ouyang, et al. Study on the Relationship Between Clinical Frailty Assessment and Adverse Postoperative Outcomes in Elderly Patients Undergoing Brain Tumor Resection. International Journal of Anesthesiology and Resuscitation, 2023, 44(3): 238-242.

[35] Y Zhang, W Fang, Y Lin, et al. Predictive Value of Lactate Dehydrogenase for Postoperative Pulmonary Infections in Glioma Patients. Journal of Fujian Medical University, 2022, 56(4): 342-346.

[36] C Zhao, H Zhao ,N An, et al. Postoperative Pulmonary Infections and Changes in Serum MMP and IGF Levels in Patients with Brain Glioma. Chinese Journal of Modern Medicine, 2022, 24(11): 22-25.

[37] X Chen, L Zhong. Analysis of Factors Influencing Postoperative Fever in Glioma Patients. Journal of Stereotactic and Functional Neurosurgery, 2021, 34(6): 362-365.

[38] H Ren, X Wang, Y Sun. Analysis of influencing factors of postoperative pulmonary infection in patients with intracranial tumor. Chin J Practical Med 2021;48(5):22–25.

[39] L Zhang, Y Peng,B Yu, et al. Analysis of Pulmonary Complications and Related Factors in Elderly Patients Undergoing Elective Craniotomy. Chinese Journal of Neurosurgery, 2018, 34(6): 606-609.

[40] C Zeng, S Wang, Yi Zhao, et al. Analysis of Complications in 90 Elderly Patients Undergoing Craniotomy for Meningioma. Chinese Medical Journal, 2010, 90(5): 298-300.

[41] H Stonnington, A Shahbandi, G Bcharah, et al. Timing and Morbidity of Intracranial Meningioma Resection Complications. World Neurosurg, 2024, 183e293-e303.

[42] Y-H Cai, H-Y Zeng, Z-H Shi, et al. Factors influencing delayed extubation after infratentorial craniotomy for tumour resection: a prospective cohort study of 800 patients in a Chinese neurosurgical centre. J Int Med Res, 2013, 41(1): 208-217.

[43] A-M Flexman, B Merriman, D-E Griesdale, et al. Infratentorial Neurosurgery Is an Independent Risk Factor for Respiratory Failure and Death in Patients Undergoing Intracranial Tumor Resection. J Neurosurg Anesth, 2014, 26(3): 198-204.

[44] LCM Sogame, M-C Vidotto, J-R Jardim, et al. Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg, 2008, 109(2): 222-227.

[45] G Dhillon, V-S Buddhavarapu, H Grewal, et al. Evidence-based Practice Interventions for Reducing Postoperative Pulmonary Complications: A Narrative Review. Open Respir Med J, 2023, 17e173008245.

[46] Liyong Zhang, Xiong Wei, Peng Yuming, et al. The effect of an intraoperative, lung-protective ventilation strategy in neurosurgical patients undergoing craniotomy: study protocol for a randomized controlled trial. Trials, 2018, 19(1): 85.

[47] Q-T Ostrom, M Price, C Neff, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016-2020. Neuro Oncol, 2023, 25(12 Suppl 2): v1-v99.

[48] H Zeng, W Chen, R Zheng, et al. Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries. Lancet Glob Health, 2018, 6(5): e555-e567.

[49] Dan Xiao, Yan Changxiang, Li Deling, et al. National Brain Tumour Registry of China (NBTRC) statistical report of primary brain tumours diagnosed in China in years 2019–2020. The Lancet Regional Health - Western Pacific, 2023, 34100715.

[50] ALC Paiva, J-L Vitorino-Araujo, R-M Lovato, et al. An economic study of neuro-oncological patients in a large developing country: a cost analysis. Arq Neuropsiquiatr, 2022, 80(11): 1149-1158.

[51] D-N Louis, A Perry, P Wesseling, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol, 2021, 23(8): 1231-1251.

[52] Q-T Ostrom, D-J Cote, M Ascha, et al. Adult Glioma Incidence and Survival by Race or Ethnicity in the United States From 2000 to 2014. JAMA Oncol, 2018, 4(9): 1254-1262.

[53] M-L Carlson, M-J Link. Vestibular Schwannomas. N Engl J Med, 2021, 384(14): 1335-1348.

[54] P Lenga, H Kleineidam, A Unterberg, et al. Optimizing patient outcome in intracranial tumor surgery: a detailed prospective study of adverse events and mortality reduction strategies in neurosurgery. Acta Neurochir (Wien), 2024, 166(1): 126.

[55] A Miskovic, A-B Lumb. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.

[56] C Keller, J Brimacombe. Bronchial mucus transport velocity in paralyzed anesthetized patients: a comparison of the laryngeal mask airway and cuffed tracheal tube. Anesth Analg, 1998, 86(6): 1280-1282.

[57] H Liu, X Wu, J Li, et al. Individualized PEEP ventilation between tumor resection and dural suture in craniotomy. 2020, 196106027.