title: Does scope of practice correlate with the outcomes of craniotomy for tumor resection in children?
abstract: The relationship of scope of practice (predominantly adult, versus predominantly pediatric) with the outcomes of brain tumor surgery in children remains uncertain. We investigated the association of practice focus with the outcomes of neurosurgical oncology operations in pediatric patients.
  
  
  
  We performed a cohort study of all pediatric patients (younger than 18 years old) who underwent craniotomies for tumor resections from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. In order to control for confounding, we used propensity score conditioning with mixed effects analysis to account for clustering at the hospital level.
  
  
  
  During the study period, there were 770 pediatric patients who underwent craniotomy for tumor resection and met the inclusion criteria. Of these, 370 (48.1%) underwent treatment by providers with predominantly adult practices and 400 (51.9%) by physicians who operated predominantly on children. Mixed-effects multivariable regression analysis demonstrated lack of association of predominantly adult practice with inpatient mortality (OR, 1.12; 95% CI, 0.48-2.58), and discharge to a facility (OR, 1.25; 95% CI, 0.77-2.03). These associations persisted in propensity-adjusted models.
  
  
  
  In a cohort of pediatric patients undergoing craniotomy for tumor resection from a comprehensive all-payer database, we did not demonstrate a difference in mortality, and discharge to a facility between providers with predominantly adult and predominantly pediatric practices.
authors.affiliation: Department of Neurosurgery, CNS Healthcare Foundation, Akron General Hospital-Cleveland Clinic, Akron, OH, USA.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. kbekelis@gmail.com.|The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. kbekelis@gmail.com.|Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03755, USA. kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000009:adverse effects* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D000069471:Neurosurgeons / Q000592:standards; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D010818:Practice Patterns, Physicians'
keywords: Craniotomy for tumor resection; Pediatrics; SPARCS; Scope of practice