title: Short-term mortality following surgical procedures for the diagnosis of pediatric brain tumors: outcome analysis in 5533 children from SEER, 2004-2011.
abstract: OBJECT Thirty-day mortality is increasingly a reference metric regarding surgical outcomes. Recent data estimate a 30-day mortality rate of 1.4-2.7% after craniotomy for tumors in children. No detailed analysis of short-term mortality following a diagnostic neurosurgical procedure (e.g., resection or tissue biopsy) for tumor in the US pediatric population has been conducted. METHODS The Surveillance, Epidemiology and End Results (SEER) data sets identified patients ≤ 21 years who underwent a diagnostic neurosurgical procedure for primary intracranial tumor from 2004 to 2011. One- and two-month mortality was estimated. Standard statistical methods estimated associations between independent variables and mortality. RESULTS A total of 5533 patients met criteria for inclusion. Death occurred within the calendar month of surgery in 64 patients (1.16%) and by the conclusion of the calendar month following surgery in 95 patients (1.72%). Within the first calendar month, patients < 1 year of age (n = 318) had a risk of death of 5.66%, while those from 1 to 21 years (n = 5215) had a risk of 0.88% (p < 0.0001). By the end of the calendar month following surgery, patients < 1 year (n = 318) had a risk of death of 7.23%, while those from 1 to 21 years (n = 5215) had a risk of 1.38% (p < 0.0001). Children < 1 year at diagnosis were more likely to harbor a high-grade lesion than older children (OR 1.9, 95% CI 1.5-2.4). CONCLUSIONS In the SEER data sets, the risk of death within 30 days of a diagnostic neurosurgical procedure for a primary pediatric brain tumor is between 1.16% and 1.72%, consistent with contemporary data from European populations. The risk of mortality in infants is considerably higher, between 5.66% and 7.23%, and they harbor more aggressive lesions.
authors.affiliation: Pediatric Neurosurgery and.|Adult and Child Center for Health Outcomes Research;
authors.forename: Todd C
authors.initials: TC
authors.lastname: Hankinson
authors.affiliation: Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centers, Montreal, Quebec, Canada.
authors.forename: Roy W R
authors.initials: RW
authors.lastname: Dudley
authors.affiliation: Adult and Child Center for Health Outcomes Research;
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Torok
authors.affiliation: Pediatric Neurosurgery and.
authors.forename: Mohana Rao
authors.initials: MR
authors.lastname: Patibandla
authors.affiliation: Division of Neuro-oncology, Department of Pediatrics;
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dorris
authors.affiliation: University of Colorado School of Medicine;
authors.forename: Seerat
authors.initials: S
authors.lastname: Poonia
authors.affiliation: Pediatric Neurosurgery and.
authors.forename: C Corbett
authors.initials: CC
authors.lastname: Wilkinson
authors.affiliation: Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado;
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bruny
authors.affiliation: Pediatric Neurosurgery and.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Handler
authors.affiliation: Department of Radiation Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; and.
authors.forename: Arthur K
authors.initials: AK
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: 30-day mortality; ACS NSQIP = American College of Surgeons National Quality Improvement Program; AT/RT = atypical teratoid/rhabdoid tumor; GTR = gross-total resection; ICD-O-3 = International Classification of Diseases for Oncology, 3rd Edition; NIS = Nationwide Inpatient Sample; NOS = not otherwise specified; NRTC = National Registry of Childhood Tumors; PNET = primitive neuroectodermal tumor; SEER = Surveillance, Epidemiology and End Results; STR = subtotal resection; Surveillance, Epidemiology and End Results; oncology; pediatric brain tumor