In-hospital mortality among intracranial tumor admissions at a tertiary hospital in Luanda, Angola: a retrospective cohort study

Abstract Background In-hospital death among patients admitted with intracranial tumors is a clinically important short-term outcome because it reflects acute neurological deterioration, treatment timing, and the capacity of hospital care pathways. Outcome reporting from African neuro-oncology settings remains limited. Methods We performed a retrospective cohort study of 93 consecutive admissions recorded between January 2020 and December 2025 at the Neurosurgery Service of Hospital do Prenda, a tertiary hospital in Luanda, Angola, which was the sole data source for this study. The unit of analysis was the admission; because the anonymized registry does not allow reliable patient-level linkage, the number of unique patients and any repeat admissions could not be determined. The primary outcome was in-hospital death. Univariable analyses examined age, sex, surgery, length of stay, registry-based diagnostic group, and admission year. Because only 21 deaths occurred (fewer than ten events per candidate variable), a pre-specified, restricted Firth penalized logistic regression sensitivity analysis was limited to three predictors: age (per 10-year increase), surgery, and a high-risk registry diagnosis category (glioblastoma or metastatic disease versus other registry diagnoses). Reporting followed STROBE and RECORD principles. Results Twenty-one of 93 admissions ended in in-hospital death (22.6%). Age ≥ 50 years was associated with death (odds ratio [OR] 4.51, 95% confidence interval [CI] 1.61–12.67; p = 0.004), and admissions ending in death were older on continuous analysis ( p = 0.019). Sex, surgery, and length of stay were not associated with death in univariable analysis. Mortality differed across registry diagnostic groups overall ( p = 0.010). In the penalized complete-case model (89 admissions, 21 deaths), high-risk registry diagnosis remained associated with death after adjustment (OR 5.70, 95% CI 1.58–20.52; p = 0.008), whereas age (OR 1.32 per 10 years, p = 0.117) and surgery (OR 0.79, p = 0.669) were not; with only 21 events, these estimates are exploratory and susceptible to residual confounding. Conclusions In this exploratory Angolan cohort, older age and a high-risk registry diagnosis were associated with in-hospital death in univariable analysis. After restricted adjustment, the association with high-risk registry diagnosis persisted, whereas the age estimate became imprecise and crossed the null; with only 21 deaths, these findings are hypothesis-generating and do not establish a ranking of determinants. The observed null association for surgery should not be interpreted causally, as patients selected for surgery likely had better performance status and more resectable tumors.