Thirty-day surgical morbidity and risk factors in pediatric brain tumor surgery: a 10-year nationwide retrospective study

Kasper Amund Henriksen Departments of Pediatrics and Adolescent Medicine,
Faculty of Health and Medical Sciences, University of Copenhagen;
Neurosurgery, and

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 BSc
,
Ninna Brix Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg;

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 MD, PhD
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Ruta Jakubauskaite Radiology, University Hospital Rigshospitalet, Copenhagen;

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 MD, MSc
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Gorm Von Oettingen Department of Neurosurgery, Aarhus University Hospital, Aarhus; and

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 MD, PhD
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Mathias Rathe Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark

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 MD, PhD
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Jane Skjøth-Rasmussen Faculty of Health and Medical Sciences, University of Copenhagen;
Neurosurgery, and

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 MD, PhD
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Jon Foss-Skiftesvik Departments of Pediatrics and Adolescent Medicine,
Neurosurgery, and

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René Mathiasen Departments of Pediatrics and Adolescent Medicine,
Faculty of Health and Medical Sciences, University of Copenhagen;

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 MD, PhD
Publication Date:
17 Nov 2023
Page Range:
1–9
Volume/Issue:
Publish Before Print
DOI link:
https://doi.org/10.3171/2023.9.PEDS23351
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OBJECTIVE

Pediatric neuro-oncological surgery is often associated with significant risk; however, comprehensive data on surgical morbidity remain limited. The purpose of this study was therefore to provide national population-based data on both the incidence and characteristics of poor postoperative outcomes following pediatric intracranial neuro-oncological surgery. Additionally, the authors aimed to evaluate key risk factors for poor postoperative outcomes including overall morbidity, significant morbidity, and the most frequent types of morbidity.

METHODS

The authors conducted a registry-based, nationwide, retrospective study including all children receiving surgical treatment for a CNS tumor over a 10-year period. Patients were identified using the Danish Childhood Cancer Registry, and 30-day morbidity was assessed through manual review of electronic health records. Significant morbidity was defined as complications in need of treatment under general anesthesia, ICU admission, or persistent neurological deficits at 30 days following surgery or death. Risk factors including sex, age, tumor location, tumor malignancy grade, and preoperative hydrocephalus were investigated using multivariate logistic regression analysis.

RESULTS

A total of 349 children undergoing 473 tumor procedures were included, with an overall morbidity rate of 66.0% and a significant morbidity rate of 34.2%. The most frequent complications included neurological deficits (41.4%) and CSF-related morbidity consisting of CSF leaks, pseudomeningoceles, and postoperative hydrocephalus. Highly significant associations between infratentorial tumor location and both significant morbidity (OR 1.26, 95% CI 1.11–1.43; p < 0.001) and neurological deficits (OR 1.38, 95% CI 1.21–1.57; p < 0.001) were identified. In addition, younger age was revealed as a major risk factor of both postoperative CSF leakage and CSF-related morbidity in general.

CONCLUSIONS

In this large, population-based cohort, the authors show that postoperative morbidity is frequent, occurring in about two-thirds of all patients, largely driven by neurological deficits and CSF-related complications. In addition, infratentorial tumor location and younger age emerged as key risk factors for poor postoperative outcomes.

ABBREVIATIONS

DCCR = Danish Childhood Cancer Registry; EHR = electronic health record.

Supplementary Materials

    • Supplementary Tables 1-8 (PDF 508 KB)
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Contributor Notes

Correspondence Kasper Amund Henriksen: University Hospital Rigshospitalet, Copenhagen, Denmark. kasper.amund.henriksen@regionh.dk.

INCLUDE WHEN CITING Published online November 17, 2023; DOI: 10.3171/2023.9.PEDS23351.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

J.F.S. and R.M. share senior authorship of this work.

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