Estimating post-operative complication rates in patients with primary brain tumours from routine administrative data: A national cohort study
Radvile Mauricaite, Alex Bottle, Andrew Brodbelt, Kerlann Le Calvez, Peter Treasure, Stephen J. Price, Thomas C. Booth, Seema Dadhania, Jonathan J. Gregory, Maureen Dumba, Joanne Droney, Jawad Basharat ,Matt Williams
Abstract
Neurosurgery is an important element of brain tumour treatment but carries with it the risk of complications. Previous work has defined a narrow set of general post-operative complications which are used as Patient Safety Indicators (PSIs), but these are not brain tumour specific and do not capture the full range of complications.
Introduction
Primary Brain and Central Nervous System (CNS) tumours are a group of rare, heterogenous diseases, including benign and malignant tumours, most of which occur in the brain rather than the spine. The commonest tumours are Glioblastoma (GBM; WHO Grade 4 glioma) and meningioma, which between them account for >50% of all adult brain tumours.
Materials and methods
The GlioCova project holds data on all adults with brain tumours diagnosed in England from 2013–2018, with treatment and survival data available until August 2020. Data was extracted on the 10th of August 2020, with mortality data (= survival) censored in October 2022.
Results
We identified 29,467 patients with a primary CNS tumour who underwent a surgical intervention. We excluded 318 patients who underwent biopsy and surgery on different days (see S8 Fig), 81 patients with an incorrect interval from diagnosis to operation, and a further 7 patients who were duplicates.
Discussion
We have used a large, comprehensive cohort of all adults undergoing first surgical intervention for a primary brain tumour over a six-year period in England to define an expanded set of post-operative complications. We have shown the OECD-defined PSI capture a small proportion of patients with complications compared to the newly defined ICL list of complications.
Acknowledgments
This work uses data provided by patients and collected by the NHS as part of their care and support. We want to thank Nicola Glover for collaboration regarding clinical coding.
Citation: Mauricaite R, Bottle A, Brodbelt A, Le Calvez K, Treasure P, Price SJ, et al. (2026) Estimating post-operative complication rates in patients with primary brain tumours from routine administrative data: A national cohort study. PLoS One 21(2): e0342011. https://doi.org/10.1371/journal.pone.0342011
Editor: Athanasios G. Pantelis, Athens Medical Group, Psychiko Clinic, GREECE
Received: August 5, 2025; Accepted: January 15, 2026; Published: February 19, 2026
Copyright: © 2026 Mauricaite et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: We are open to collaborating with research teams as we believe in sharing knowledge. If people are interested in working on Gliocova, they can contact us to enquire about data access. The data is securely held on Imperial College London servers so arrangements will need to be made prior to access. We have a data-sharing agreement with NHS England/Digital that prevents us from freely sharing data, as we have access to individual patient level NHS data. Furthermore, we have REC approvals (REC reference: 16/YH/0213) that only allow us to share aggregated data and not pseudo-anonymised data. You can contact the ethics committee here: sheffield.rec@hra.nhs.uk.
Funding: This work was funded by National Institute for Health Research (NIHR) Biomedical Research Council (BRC), RM Partners hosted by the Royal Marsden NHS Foundation Trust and Imperial College Healthcare NHS Trust. SJP is funded by a NIHR Career Development Fellowship (CDF-18-11-ST2-003). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ABo is funded by the National Institute for Health and Care Research. TCB is funded by the Wellcome Trust 2022-2023 (Award number: 203148/A/16/Z).
Competing interests: Dr. Williams is employed by Imperial College Healthcare NHS Trust. He is also the medical director of PearBio (salary and share options). Stephen J. Price is an advisor for TUMOURVUE Ltd (no financial involvement) and is the Chair of the Education Committee of the European Association for Neuro-oncology (EANO). He is on the speaker board for Medac GmbH and organises courses to train surgeons to use 5-ALA for which he is reimbursed, but has not run such a course since 2019. Alex Bottle declared obtaining fees from AstraZeneca and Lilly outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
