NCOG-50 Association of preoperative comorbidity burden with early postoperative functional status across multiple intracranial tumor subtypes: lessons for resource-limited settings

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Background and Aim Postoperative outcome prediction in neurosurgical oncology remains challenging, particularly in resource-limited settings. While tumor- and surgery-related factors are well studied, the impact of preoperative comorbidity burden on early postoperative outcomes is poorly defined. This study addresses a critical gap by evaluating multiple CNS tumor types using standardized comorbidity scoring. Methods This retrospective cohort study involving the data from 2022 to 2024 was conducted at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan. It evaluated the association between preoperative CCI scores and early postoperative outcomes, including 30-day mortality, complications, and functional status. Results Of the total 385 with an overall mean age of 39.5±15.3 years, 53.2% (205) were males. The most common groups were meningioma 31.6% (122), pituitary adenoma 26.4% (102), and vestibular Schwannoma in 25.9% (100) patients. The mean CCI score was 2.8±1.42 (Median: 2). The 30-days postoperative mortality was reported in 4.9% (19) patients. Chi-square test revealed a statistically significant association between CCI category and mortality (χ² = 3.97, p = 0.046), yet there was no significant association between CCI category and postoperative complications, functional outcomes (p > 0.05). Mann-Whitney U-test revealed no significant difference in mean postoperative GCS and KPS scores between low and high CCI group. Logistic regression analysis revealed higher odds of postoperative mortality in high CCI group. Contrary to this, linear regression demonstrated lower postoperative KPS in patients with high CCI (B = −6.685, p = 0.001). Conclusion Higher CCI scores were associated with increased 30-day postoperative mortality and poorer early functional outcomes. Although CCI did not predict postoperative complications or early neurologic status, a consistent trend toward higher mortality was observed with increasing comorbidity burden.