Predicting postoperative hospice enrollment following stereotactic brain biopsy: a retrospective study and risk score development.

Abstract

Objective: Stereotactic brain biopsy (SBB) is a key diagnostic tool in neuro-oncology. Due to the poor prognosis for many tumors, a significant subset of patients transition to hospice care shortly after the procedure. Current tools inadequately predict which patients are less likely to benefit from SBB. This study aimed to define preoperative factors that limit enrollment in adjuvant treatment in SBB candidates by characterizing patients who enrolled in hospice soon after the procedure. Understanding the safety profile and diagnostic utility of SBB in the context of hospice enrollment is essential for making informed decisions.

Methods: A retrospective analysis was conducted on 616 patients who underwent SBB between 2000 and 2022 at a tertiary academic center with additional cost-of-care data up to 2025. Clinical, surgical, and pathological data were analyzed. The primary outcome was hospice enrollment within 1 month postoperatively. Multivariable Firth logistic regression identified key predictors, which were used to develop and validate probabilistic pre- and postoperative risk scores. A secondary cost analysis compared financial burdens between hospice and nonhospice patients.

Results: One-month hospice enrollment occurred in 12.7% of patients. Independent predictors of hospice enrollment included age ≥ 60 years, basal ganglia biopsy, mental status deficits, Karnofsky Performance Status (KPS) score ≤ 50, prolonged intensive care unit stay, and grade 4 glioma. The comprehensive risk score achieved an optimism-corrected area under the receiver operating characteristic curve (AUC) of 0.81 at train time (0.85 test), with high-risk test-set patients having an 88.9% probability of 1-month hospice enrollment. The preoperative-only risk score attained a train time AUC of 0.78 (0.82 test). Patients progressing to hospice incurred significantly higher in-hospital care costs ($54,499 vs $35,967). Preoperative functional impairment (as measured by the KPS score) was also associated with higher 1-year hospice enrollment and 1-year mortality rates.

Conclusions: This study presents a validated risk model predicting early hospice enrollment after SBB. Incorporating this tool into preoperative assessment may support clinicians in informed counseling, reduce unnecessary procedures or treatment, enhance shared decision-making, and mitigate financial burden, ultimately promoting patient-centered neuro-oncological care.