# Prolonged preoperative wait time associated with elevated postoperative thirty-day mortality following intracranial tumor craniotomy in adult patients: A retrospective cohort study

## TL;DR

Longer wait times before brain tumor surgery are linked to higher short-term death risk in adult patients.

## Contribution

This study identifies a linear relationship between preoperative wait time and 30-day mortality after intracranial tumor surgery.

## Key findings

- Each additional day of waiting increases 30-day mortality risk by 8.3% in non-ventilator-dependent patients.
- Patients waiting ≥1 day had a 31.3% higher relative risk of 30-day mortality compared to those waiting <1 day.
- The association was only observed in non-ventilator-dependent patients.

## Abstract

Prior studies have established preoperative wait time as a potential risk factor for postoperative outcomes across various clinical conditions. However, associations between wait time and short-term prognosis following intracranial tumor surgery are still largely unknown. Our study sought to investigate associations between preoperative wait time and postoperative thirty-day mortality following intracranial tumor craniotomy in adult patients.

This retrospective cohort study utilized data extracted from the ACS NSQIP database, comprising 18,298 adult patients who underwent intracranial tumor craniotomy between 2012 and 2015. The primary exposure and outcome were preoperative wait time and postoperative thirty-day mortality, respectively. Smooth curve fitting evaluated the linear or nonlinear association between them. The effects of exposure on outcome were evaluated using multivariate Cox proportional hazard regression models and Kaplan-Meier curves. Subgroup analyses and interaction testing were conducted to evaluate the effect modification of confounding factors. The robustness of the main results was assessed through propensity score matching and sensitivity analyses.

Prolonged preoperative wait time was independently and linearly related to elevated thirty-day mortality (HR = 1.075, 95%CI: 1.040–1.110). The ventilator-dependent status significantly modify the relationship between wait time and mortality. The linear wait time-mortality association was observed solely in non-ventilator-dependent patients, showing an 8.3% increase in thirty-day mortality risk for each additional day of waiting (HR = 1.083, 95%CI: 1.049–1.119). Patients who waited ≥1 day had a 0.74% higher absolute risk and a 31.3% higher relative risk of thirty-day mortality compared to those who waited <1 day. The sensitivity analyses corroborated the robustness of these results.

Prolonged preoperative wait time has an independent linear association with elevated postoperative thirty-day mortality in non-ventilator-dependent adult patients undergoing intracranial tumor craniotomy. Clinicians should minimize preoperative wait time to mitigate the risk of thirty-day mortality. Nonetheless, further research is warranted to validate the results and establish causality.