In-hospital mortality and complications following
surgical resection of glioblastoma
Chevalier P1, Van Gils C1, Lamotte M1
1QuintilesIMS, RWES, Zaventem, Belgium;
Introduction
Glioblastoma multiform (GBM) is a very aggressive form of brain tumour, accounting for
about 15% of all brain tumours. Tumour resection, with or without administration of adjuvant
chemotherapy, is the first-line treatment for patients diagnosed with glioblastoma. However,
there is a paucity of real-life data regarding the complications/ mortality associated with this
type of surgery in Belgium.
This study aimed at describing the in-hospital mortality/ complications associated with the
surgical resection of glioblastoma in Belgian patients, using retrospective data.
Methods
Study design: Retrospective database analysis
Data source: IMS RWD Hospital Data - Belgium– covering about 25% of all hospital beds
in Belgium (located in North and Brussels)
Information available in database:
• Demographic variables: age, gender
• Diagnoses and procedures: ICD-9-CM codes, APRDRG and severity level
• Characteristics of hospitalization: LOS (total and per service), admission via an
emergency room (ER) and in-hospital mortality
• Resource use: details on all procedures performed and all drugs invoiced during the
hospitalization
• Information on medications includes ATC category, molecule name, brand name,
dosage, number of units dispensed, administration start-date and end-date. However,
limited information is available on drugs dispensed from the hospital pharmacy but
not during a hospitalization
Time frame of study: full 2013-2014 period
Table 1: ICD-9 codes used for patient selection
Indication
Brain tumors (ICD-9 diagnosis
codes)
excluding
Code
191.0–191.9
Glioblastoma (ICD-0 codes)
Brain biopsies (ICD-9
procedure codes)
Pressure relief surgery (ICD-9
procedure codes)
Resection of brain tissue (ICD9 procedure codes)
Complications (ICD-9
diagnosis/ procedure codes)
Label
191.6
191.7
M9440/3
M9441/3
Malignant neoplasm of cerebellum
Malignant neoplasm of brain stem
Glioblastoma, not specified
Giant cell glioblastoma
01.13
Percutaneous biopsy of brain
01.14
Open biopsy of brain
01.24
Other craniotomy (including cranial decompression)
01.52
Hemispherectomy
01.53
Lobectomy of brain
01.59
Other excision or destruction of lesion of tissue of brain
(including transtemporal excision of brain tumour)
997.02
Cerebrovascular haemorrhage – post operative stroke
998.12
331.3-331.4
02.2 (Proc)
451.1,451.2
& 453.4
Hematoma complicating a procedure
Hydrocephalus
Ventriculostomy
Pulmonary embolism
Figure 1: Invasive procedures
Selection of eligible population:
• Hospitalizations were selected based on the presence of an ICD-9-CM diagnosis
code for primary brain tumour combined with a ICD-0 code for glioblastoma (see
Table 1)
Exclusion criteria:Patients with a concomitant diagnosis for another tumor (ICD-9 codes
140-209)
Follow-up period: from first diagnosis of GBM until death/ end of study period
Identification of chemotherapy treatments:
• Chemotherapy sessions were identified based on a diagnosis code for
chemotherapy or documented administration of a chemotherapeutical agent (ATC
category L01)
• When no agent was documented, the regimen was labeled as “Unknown”
• Complex administration schedules were captured based on exact dates of
administration
Study endpoints:
• % of invasive procedures
• % of post-surgery complications
• Kaplan Meier estimates: time to post-surgery chemotherapy
Figure 2: Post-surgery complications
Post-surgery mortality
Any of the selected
complications
Pulmonary embolism
Ventriculostomy
Results
A total of 709 GBM patients were retrieved in the data (average age: 62.9 years; 60.6%
male). Invasive procedures were documented in 53.9% (n=382).
• 23.1% of the patients (n=164) had a biopsy
• 1.4% (n=10) underwent pressure relief surgery
• Resection surgery (lobectomy/ mastoid excision) was documented in 36.1% (n=256).
However, it was most likely under-documented due to the fact that not all hospital in
the database have capacity to perform such surgery (so surgery was performed in
another hospital). Among those patients,
• 4.7% (n=12) died during hospitalization
• 12.5% (n=32) experienced post-surgery complications (including haemorrhage:
8.2% [n=21]; hematoma: 2.0% [n=5]; hydrocephalus: 2.0% [n=5];
ventriculostomy: 1.2% [n=3]; pulmonary embolism: 0.8% [n=2]).
The average length of stay (LOS) for resection surgery was 20.0 days, with a significantly
higher LOS in patients with complications (42.1 days vs. 16.2 days without complication;
p<0.001).
For 26.6% (n=68) of the patients having undergone surgery, a chemotherapy was
documented post-surgery, mostly with temozolomide [n=48]. In the majority of cases,
chemotherapy was initiated within the first month following surgery (Figure 3).
12.5% (n=32)
0.8% (n=2)
1.2% (n=3)
Hydrocephalus
2.0% (n=5)
Hematoma
2.0% (n=5)
Post-operative stroke
0.0%
8.2% (n=21)
2.0%
4.0%
6.0%
Figure 3: Time to post-surgery chemotherapy
Conclusions
The surgical resection of glioblastoma may be associated
with severe and potentially lethal complications,
significantly impacting length of stay.
FOR FURTHER INFORMATION: Please contact - Pierre Chevalier: [email protected]
ISPOR 19th Annual European Congress, Vienna, Austria; 29 October – 02 November 2016 (PCN45)
Copyright © 2016 QuintilesIMS. All rights reserved.
4.7% (n=12)
8.0%
10.0%
12.0%
14.0%