Value-based assessment of repeat surgery for recurrent glioma: a real-world quality-adjusted survival analysis

Abstract Background Reoperation for recurrent glioma is widely practiced, yet clinical decision-making remains challenging due to substantial trade-offs between survival gain and postoperative functional burden. High-quality real-world evidence integrating survival and quality-of-life outcomes to inform reoperation decisions remains limited. Methods We conducted a retrospective real-world cohort study of 1,304 adult patients with recurrent glioma treated between 2010 and 2018. Propensity score matching was applied to balance baseline characteristics. Survival outcomes, quality-adjusted life years (QALYs), functional status, and prognostic factors associated with reoperation benefit were evaluated. Results In the 1:1 propensity-matched cohort (140 reoperation vs 140 non-reoperation), reoperation was associated with a mean gain of 9.6 months in quality-adjusted life years (QALYs) and a 521-day longer overall survival. Postoperative functional status showed short-term improvement. In the glioblastoma subgroup, reoperation was associated with a numerical gain of 3.5 QALY months, although the confidence interval crossed zero, alongside a 218-day gain in overall survival. Predictive models based on preoperative characteristics demonstrated good discrimination in identifying patients likely to derive survival benefit beyond six months. Conclusions This study provides real-world evidence that carefully selected patients with recurrent glioma may derive quality-adjusted survival benefits from reoperation, thereby supporting individualized surgical decision-making. These findings have implications for value-based surgical decision-making in recurrent glioma, particularly in healthcare systems where balancing survival benefit against functional outcomes and resource use is increasingly important.